
Class _r 



Book ■*■& 13. 



ightN? 



COPYRIGHT DEPOSIT. 



BUCHANAN'S 

ZDOZfcvSES'XXC PBilCTICE 

or 7 

ZM-EXDICXILTiEl- 



/vr6 



THE 



FAMILY PHYSICIAN, 



^IfcTID 



DOMESTIC PRACTICE OF 
MEDICINE, 



JOHN BUCHMM, M.D.,D.C.L,LL.D. 
Atfr 

PROffJSOR Of PfiACTICt Of WtUlCINt Mb PffflOLOfiY, 



Jbid Author of" The American Practice of Medicine;" "Buchanan's 
Obstetrics;" " The Centennial Practice of Medicine;" "The Child, 
its Diseases;" "A Systematic Treatise on Midwifery f and 
Diseases of Women and Children;" "The Principles 
and Practice of Surgery;" " The Venereal Dis- 
ease;" "Spermatorrhoea, Our National 
Weakness;" "New Remedies," etc. 



PHILADELPHIA 

ZEPw. BTJSSELI 



I NOV 






Entered, according to Act of Congress, in the year 1884, 
By R. RUSSELL, 
In the Office of the Librarian of Congress at Washington. 



A. E. GRAVES, PRINTER. 

149 N. Fourth. St., Philadelphia, Pa. 



=>->^EE».2g= 






TO 1 9 H. III1FF S II. l. f 
^timiisttaft 6oj % IuHkul frmtisi}* trf ^r jimift f nuit m grate! 

THE AUTHOR. 



PUBLISHERS PREFACE. 

The Publisher commits this work to the people, believing 
that it will greatly assist them in the management of their own 
diseases and that of the family, and earnestly hopes that it will 
prove a valuable work of reference. Domestic Practices are 
inevitable in this progressive, travelling, colonizing age, not 
only as works of reference, but of great value in quickening the 
medical appetite so as to secure more appropriate means to 
preserve human health. 

The author is a practitioner of forty years' standing, of most 
extensive experience, an author of great versatality, a Professor 
in the most celebrated universities of Europe and America, and 
thoroughly conversant with the wants of the people in their 
search after health. He also has made many important dis- 
coveries in the art of medicine invaluable to mankind, and no 
one understands more thoroughly the true nature of our people, 
their idiosyncrasies, their diseases, and best means to be adopted 
in their cure. 

The ripe experience, the devotion and zeal, which the author 
has brought to contribute to the production of this work will 
stamp his name upon the annals of medical literature, art and 
progress with a fame that can never dim or die ; for art and 
literature live forever; our politicians reign for a day, and re- 
tire to obscurity ; our men of wealth build palaces, and hold 
banquets, and control great financial interests, and go down in 
disaster; our men of society court the various powerful mate- 
rial interests of the world, and rejoice in their patronage for a 
season, and then disappear like the ephemera of the twilight; 
but art and literature live forever ; if a man add to these treas- 
ures he adds to the permanent possessions of the nation : navies, 
armaments, wealth, are at the mercy of war ; literature is inde- 
pendent of disaster, nay, is only enriched by it — it feeds on all 
forms and phases of the national life, and grows as steadily and 
surely in adversity as in prosperity; and all those who pour 
out their lives in literature are the true national benefactors 
to be cherished, protected, encouraged, fully and freely recog- 
nized ; they are the kings, queens, and nobles of a realm which 
is above the accidents of political empires — the producers of 
treasures which cannot decay. 

The present work is imperatively demanded. The progress 
of the age; the spirit of the times; the eager, keen, grasping 



medical appetite; the present revolution in the medical world; 
the inauguration and elucidation of the germ theory of disease. 

It has received the highest commendations, the heartiest ap- 
proval, of all liberal practitioners. Physicians of all schools 
have endorsed the treatment laid down ; the appliances and 
remedies selected and recommended, as the best and safest, on 
which the greatest reliance can be placed. 

It contains no sentiment that will, in the least, militate or 
conflict with any ennobling effort to alleviate human suffering, 
prolong life, or produce a nobler type of manhood. 

The spirit of the work is reflected on its every page; princi- 
ples are inculcated that tend to make the mind purer and the 
heart better ; a more rational treatment of disease is laid down, 
based upon good common sense ; all the landmarks and mile- 
stones between disease and death are plainly marked out, and 
all curative measures based upon a renewal of life. 

It sets forth in vivid light a rational system of cure ; con- 
structive treatment ; the duties of nurse and physician ; the 
necessity of a universal dissemination of medical knowledge 
among the masses. 

A perusal of the table of contents will show that it embraces 
a description of over Seven Hundred Diseases, with their treat- 
ment, thus forming a perfect Encyclopaedia of Domestic Medicine. 



CONTENTS. 



I. INTRODUCTION. 

Medicine a Science, 17 

The Caucasian a Distinct Race, 20 

The Determination of the Sexes, 22 

Pathology, 27 

Psychology, 28 

Our National Weakness, 30 

What are Disease Germs ? 34 

Deterioration of Race, 37 

Effects of Fashion, 37 

How to Breathe, 39 

How to Guard against Disease, 41 

Personal Health, 42 

II. DIAGNOSIS. 

How to Recognize Disease, 43 

Inspection, 43 

Palpation, 44 

Mensuration, 45 

Percussion, 45 

Auscultation, 48 

The Heart, in Health and Disease, 50 

The Pulse, 52 

The Tongue, 53 

The Skin, 54 

The Appetite, 54 

Thirst, 54 

Alterations in Color, 55 

Sensations, 56 

Emaciation, 56 

Posture and Gait, 57 

Position, 57 

Expression, 58 

Character of Stools, 58 

Respiration, 59 

Temperature, 59 

Smell, 60 

Weight ofthe Body, 61 

Character of the Urine, 62 

Microscope, 64 

Vital Capacity of the Lungs, 64 

Electricity, 65 

Sphygmograph, 6Q 

Spinal Diagnosis, 66 

Longevity, 66 

Temperaments, 67 



11 CONTENTS. 

III. DISEASE ; FEVEK, INFLAMMATION. 

Disease, 69 

Shock, Prostration, Collapse, 69 

Fever, 70 

Inflammation, 74 

Classification of Fevers, 80 

Simple Continued or Ephemeral Fever, 80 

Gastric Fever, 81 

Simple Bilious Fever, 82 

Intermittent or Malarial Fever or Ague, 83 

Remittent Fever, 88 

Bilous Remittent, 91 

Remittent Bilious Malignant, 91 

Relapsing Fever, 91 

Typhoid Fever, 92 

Typhus Fever, 99 

The Plague, 102 

Yellow Fever, 102 

Dengue, 105 

Erysipelas, 106 

Diphtheria, 107 

Spotted Fever, or Cerebro-spinal Meningitis, 110 

Puerperal Fever, 111 

Anthrax, 113 

Surgical Fever, 116 

Eruptive Fevers, 118 

Measles, or Rubeola, 118 

Rubeola Notha or Rotheln, 119 

Scarlet Fever, 120 

Small-pox, 125 

IV. DISEASES OF THE BLOOD. 

Scrofula, Tuberculosis, Struma, 130 

Carcinoma, 135 

Syphilis, or Venereal Disease, 141 

Gonorrhoea, 142 

Systemic Syphilis, 144 

Anaemia, 148 

Chlorosis, 151 

Leucocythaemia, 152 

Adenoma, 153 

Graves's Disease, 153 

Purpura, 154 

Black Leg, 155 

Scurvy, 155 

Palagra, or Scurvy of the Hills, 156 

Bronchocele, 157 

Cretinism, 158 

Embolism, 158 

Piarrhsemia, 159 

Glucohaemia or MeliturLa, 160 

Uraemia, 161 

Acholia, 161 

Ichorrhaemia, 162 

Rheumatism, 163 

Chronic Rheumatism, 166 

Gout, 168 

Rheumatoid Arthritis, 171 

Haematozoa, 171 

Hydrophobia, 172 

Glanders, 174 



CONTENTS. Ill 



IV. DISEASES OF THE BLOOD {continued) : 

Bites of Rabid Animals, Venomous Reptiles, 175 

Poison of Subject, 176 

Hemorrhagic Diathesis, 178 

Fatty and Amyloid Degeneration, 178 

Calcareous or Mercurial Degeneration, 179 

Mercurial Poisoning, 179 

Phosphorus Disease, 180 

Brass Founders' Disease, 181 

V. DISEASES OF THE NERVOUS SYSTEM. 

Vertigo, 182 

Headache, 183 

Sleeplessness, 184 

Coma, 184 

Cerebral Inflammation, 185 

Acute Inflammation of Brain, 186 

Acute Simple Meningitis, 188 

Tubercular Meningitis, 190 

Chronic Inflammation, 192 

Induration of Brain, 194 

Abscess of the Brain, 194 

Red Softening of Brain, 194 

White Softening of Brain, 194 

Deposits, Tumors in Brain, 195 

Hydrocephalus, 195 

Hydrocephaloid, 197 

Aphasia, 197 

Apoplexy, 198 

Concussion of the Brain, 200 

Hypertrophy of Brain, 201 

Atrophy of Brain, 201 

Haemorrhage in the Brain, 201 

Delirium Tremens or Chronic Alcoholism, 202 

Coup de Soleil or Sunstroke, 204 

Epilepsy, 205 

Epilepsv, Infantile, 209 

Catalepsy, 210 

Convulsions, 211 

Puerperal Convulsions, 212 

Infantile Convulsions, 212 

Insanitv, 212 

Mania, 213 

Monomania, 213 

Melancholia, 213 

Autophomonomania, 213 

Audrophomonomania, 213 

Pyromania, 214 

Kleptomania, 214 

Theomania, 214 

Erotomania, 214 
Dementia, 214 
Acute Dementia, 214 
Idiocy, 214 

Insanity with Paralysis, 214 
Insanity with Epilepsy, 215 
Dipsomania, 215 
Puerperal Mania, 216 
Erotomania, 216 
Suicide, 216 
Nightmare, 218 



IV CONTENTS. 

V. DISEASES OF THE NEKVOUS SYSTEM (continued) : 

Home-sickness, 218 
Tetanus, or Keflex Action, 219 
Trismus Nascentium, 222 
Puerperal Tetanus, 222 
Spinal Myelitis, 223 

Chronic, 223 
Spinal Meningitis, 224 
Spinal Haemorrhage, 225 
Spinal Tumors, 225 
Spinal Irritation, 226 
Chorea, 228 

Ansemia of the Brain, Spinal Cord, Great Sympathetic, 229 
Paralysis, 238 

Hemiplegia, 238 

Paraplegia, 240 

Syphilitic Paraplegia, 242 

Local Paralysis, 242 

Locomotor Ataxia, 242 

Sclerosis of the Cord, 243 

Infantile Paralysis, 244 
Hysterical Rheumatic Paralysis, 245 
Progressive Muscular Atrophy, 245 
Pseudo-Hypertrophic Paralysis, 246 
Diphtheritic Paralysis, 246 
Mercurial Paralysis, 247 
Lead Paralysis, 247 
Paralysis Agitans, 248 
Neuralgia, 249 

Tic-douloureux, 249 

Hemicrania, 249 

Sciatica, 250 

Stammering, 251 
Neuritis, 252 
Neuroma, 252 
Habits, 252 

Tea and Coffee Habit, 252 
The Alcoholic Habit, 252 
The Tobacco Habit, 253 
The Opium Habit, 254 
The Chloral Habit, 254 
Arsenic Habit, 255 ' 

VI. DISEASES OF THE ORGANS OF CIRCULATION— HEART AND 

BLOOD-VESSELS. 
Atrophy of the Heart, 256 
Fatty Degeneration, Atrophy, 257 
Hypertrophy of the Heart, 257 
Fatty Degeneration of the Heart, 258 
Dilatation of the Heart, 260 
Carditis, 261 
Endocarditis, 261 
Pericarditis, 263 
Hydrops Pericardium, 264 
Functional Derangement of the Heart, 265 
Angina Pectoris, 266 
Valvular Disease of the Heart, 269 
Cyanosis, 273 
Rupture of the Heart, 273 
Cancer of the Heart, 274 
Aortitis, 274 



CONTENTS. V 

VI. DISEASES OF THE ORGANS OF CIRCULATION— HEART AND 

BLOOD-VESSELS (continued) : 
Hydrothorax, 274 
Aneurism, 275 
Cardiac Aneurism, 277 
Aneurism of Thoracic Aorta, 277 
Aneurism of Abdominal Aorta, 278 
Nsevus, 278 
Phlebitis, 279 
Phlegmasia Dolens, 280 
Varix, 282 

VII. DISEASES OF THE ORGANS OF RESPIRATION. 

Olfactory Nerve, 283 
Acute Nasal Catarrh, 284 
Chronic Catarrh, 285 
Ozsena, 287 
Influenza, 288 
Epistaxis, 289 
Nasal Polypus, 290 
Acute Laryngitis, 290 
Chronic Laryngitis, 291 
Laryngitis Clericorum, 293 
Aphonia, 294 
Croup, 295 

Whooping-Cough, 296 
Asthma, 298 
Emphysema, 301 
Difficulty of Breathing, 302 
Cough, 303 
Bronchitis, 304 

Acute, 305 

Chronic, 306 

Senilis, 308 

Infantile, 309 

Plastic, 309 

Mechanical, 310 

Secondary, 310 

Hay,310 
Pneumonia, Acute, 310 

Chronic, 315 
Pleurisy, Acute, 316 

Chronic, 317 
Pleurodynia, 318 
Pulmonary Condensation, 319 

Apoplexy, 319 

Febroid Infiltration, 319 

Condensation due to Collapse, 319 

Cancer, 320 

Consumption, 320 
Acute Phthisis Pulmonalis, 321 
Chronic Phthisis Pulmonalis, 322 
Cancer of the Lungs, 327 

VIIL DISEASES OF THE ORGANS OF DIGESTION— MOUTH, 
STOMACH, BOWELS. 
Diseases of the Mouth, 328 
Glossitis, 328 
Ulcers on Tongue, 328 

1. Strawberry Tongue, 328 

2. Ulcers from Malnutrition, 329 



VI CONTENTS. 

VIII. DISEASES OF THE OKGANS OF DIGESTION -MOUTH, 
STOMACH, BOWELS {continued) : 

3. Mercurial Ulcers on Tongue, 329 

4. Svphilitic Ulcers on Tongue, 329 

5. Cracked Tongue, 329 

6. Surface of Tongue, 329 

7. Warts on Tongue, 329 

8. Hypertrophy of Tongue, 329 

9. Tongue Tie,' 329 

10. Tumors on Tongue, 329 

11. Kanula, 330 
Cancer, 330 

Toothache, 330 

From Caries, 330 

Inflamed Pulp, 331 

Necrosis of Fangs, 331 

Neuralgia, 331 
Aphtha, 331 

1. Infantile Aphtha, 331 

2. Tubercular, 332 

3. Syphilitic, 332 

4. Mercurial, 332 
Inflammation of the Mouth, 33S 
Follicular Stomatitis, 333 
Ulcerative Stomatitis, 333 
Gangrenous Stomatitis, 333- 
Buccal Gland's, 334 

Acute Tonsillitis, 334 

Chronic Tonsillitis, 335 

Cancer of Tonsil, 336 

Exhalation from Tonsils, 336 

Parotitis or Mumps, 336 

Inflammation of Parotid, 337 

Pharyngitis, 337 

Syphilitic Ulcerative Pharyngitis, 3S7 

Elongation of Uvula, 337 

Dysphagia, 338 

Eetro-Pharyngeal Abscess, 338 

Oesophagitis, 338 

(Esophagism, 339 

Stricture of the (Esophagus, 339 

Cancer of the (Esophagus, 841 

Haemorrhage from the Stomach, 341 

Acute Inflammation of Stomach, 342 

Chronic Inflammation of the Stomach, 343 

Effusion of Lymph, 344 

Induration of the Pylorus, 344 

Dilatation of the Stomach, 344 

Gastric Ulcer, 345 

Cancer of the Stomach, 345 

Dyspepsia or Indigestion, 347 

Varieties, 347 
Gastric Catarrh, 351 

Catarrh of the Stomach in Children, 353 
Diseases of the Duodenum, 355 

Intestinal Dyspepsia, 355 
Perforating Ulcer of Duodenum, 355 
Cancer of the Duodenum. 355 
Enteritis, 356 
Catarrhal Enteritis, 356 
Inflammation of the Caecum, 357 



CONTENTS. Vll 

VIII. DISEASES OF THE OEGANS OF DIGESTION— MOUTH, 

STOMACH, BOWELS {continued): 
Diarrhoea, 358 

1. Feculent, 359 

2. Serous, 359 

3. Biliary, 359 

4. Mucopurulent, 360 

5. Chronic Diarrhoea, 360 

6. Diarrhoea in Tvphoid, 360 

7. Melsena, Black Stools, 360 
Constipation, 360 
Obstruction of the Bowels, 362 

Varieties, 362 
Intussusception, 363 
Intestinal Concretions, 363 
Intestinal Perforation, 364 
Flatulence, 364 
Colic, 364 

1. Flatulent, 364 

2. Bilious, 364 

3. Nervous, 365 

4. Tin, 365 

5. Copper, 365 

6. Bismuth; 365 

7. Lead, 365 
Entozoa, 366 

Varieties, 368 
Intestinal Worms, 369 
Ascarides or Seat-worms, 370 
Lumbricoides or Bound-worms, 370 
Tape-Worm, 371 
Trichiniasis, 372 
Dracontiasis, 375 
Filaria Sanguinis Hominis, 375 
Cholera, 376 

1. Infantum, 377 

2. Morbus, 379 

3. Epidemic, 380 
Dysentery, 383 
Inflammation of Bectum, 385 

• Stricture of the Bectum, 386 
Ulcers of the Bectum, 387 

1. Chronic Ulcer of the Bectum, 387 

2. Irritable Ulcer of the Bectum, 387 

3. Bodent Ulcer of the Bectum, 387 
Prolapsus of the Bectum, 387 
Polvpus of the Bectum, 389 

Bectal Neuralgia, 389 
Cancer of the Bectum, 389 
Haemorrhoids or Piles, 390 

External and Internal, 390 
Fistula in Ano, 391 

IX. DISEASES OF LIVEB, PANCBEAS, AND SPLEEN. 

Acute Inflammation of the Liver, 393 
Chronic Inflammation of the Liver, 395 
Syphilitic Hepatitis, 398 

Disease of the Blood-vessels of the Liver, 398 
' Inflammation of the Gall-Bladder, 398 
Degeneration of the Liver, 399 
Amyloid or Starchy Degeneration of Liver, 399 
Fatty Degeneration of Liver, 400 



Vlll CONTENTS. 

IX. DISEASES OF LIVER, PANCREAS, AND SPLEEN {continued) 

Pigment Liver, 401 
Atrophy of Liver, 401 
Hypertrophy of Liver, 402 
Tumors of Liver, 403 
Cancer of Liver, 404 
Gall-stones, 405 
Jaundice, 407 
Acholia, 408 
Diabetes Melitus, 409 
Disease of Pancreas, 412 
The Spleen, 413 

X. DISEASES OF THE ABDOMEN. 

Vomiting and Retching, 415 
Hiccough, 416 
Obesity, or Corpulency, 417 
Sea-Sickness, 418 
Peritonitis, 420 

Acute, 421 

Chronic, 422 
Dropsy of the Abdomen, 423 
Marasmus, or Tabes Mesenterica, 424 
Dropsv, 426 

Of the Head, 426 

Of the Chest, 426 

Of the Pericardium, 426 

Of the Abdomen, 427 

Of the Cellular Tissue, 427 
Contusion of the Walls of the Abdomen, 428 
Abscess of Abdominal Walls, 429 
Rupture or Hernia, 429 

Reducible Hernia, 430 

Irreducible Hernia, 431 

Strangulated Hernia, 431 

XL DISEASES OF THE LYMPHATIC SYSTEM. 

Lymphatics and Pink Marrow, 436 
Adenoma, or Hodgkin's Disease, 437 
Inflammation of Lymphatic Glands, 437 

XII. DISEASES OF THE URINARY ORGANS. 
Acute Inflammation of the Kidneys, 439 
Acute Desquamative Nephritis, 440 
Bright' s Disease, 441 
Fatty Degeneration of Kidneys, 445 
Amyloid Degeneration of Kidneys, 446 
Cystic Degeneration of Kidneys, 447 
Uraemia, 447 

Dropsy of the Kidney, 447 
Cancer of the Kidney, 448 
Tubercle of the Kidney, 448 
Parasites in the Kidney, 449 
Diuresis, 449 
Chyluria, 450 
Hematuria, 450 

Red Gravel, or Uric Acid Diathesis, 451 
White Gravel, or Phosphatic Diathesis, 452 
Oxalic Acid Diathesis, Oxaluria, 454 
Nephralgia, or Neuralgia of Kidney, 455 



CONTENTS. IX 

XII. DISEASES OF THE URINARY ORGANS (continued) : 

Urinary Calculi, or Stone, 457 
Disease of Suprarenal Capsules, 459 
Acute Inflammation of Bladder, 460 
Chronic Inflammation of Bladder. 461 
Incontinence of Urine, 462 
Continence of Urine, 464 
Irritable Bladder, 465 
Spasm of the Bladder, 466 
Paralysis of the Bladder, 466 
Tumors in the Bladder, 467 

XIII. DISEASES OF THE MALE ORGANS OF GENERATION. 

Balanitis, 468 
Phymosis, 469 
Paraphimosis, 470 
Herpes Pre put ia lis, 471 
Inflammation of the Urethra, 471 
Stricture of the Urethra, 472 
Fistula in Urethra, 473 
Malformations of Urethra, 474 

1. Hypospadias, 474 

2. Epispadias, 474 
Gleet, 474 

Hemiplegia of Penis, 475 
Priapism, 475 

Bubo, 475 

Acute Inflammation of Prostate Gland, 476 

Chronic Inflammation of Prostate Gland, 477 

Prostatorrhcea, 480 

Cancer of the Penis, 481 

Inflammation of Testicles, Testitis, 481 

1. Acute Testitis, 481 

2. Chronic Testitis, 483 

3. Abscess and Fungus of Testicle, 483 

4. Tubercular Testis, 484 
Neuralgia of the Testis, 484 

Atrophy and Hypertrophy of Testicle, 485 
Varicocele, 485 
Circocele, 486 
Scrotal Effusions, 486 

1. Hydrocele of Tunica Vaginalis, 486 

2. Hydrocele of Cord, 487 

3. Hematocele, 487 

4. Scrotal (Edema, 487 

5. Phagedena Scrotum, 487 

6. Scrotal Elephantiasis, 488 
Spermatorrhoea and Masturbation, 488 
Impotency and Sterility, 495 

1. Impotence in Man, 495 

2. Impotence in Woman, 497 

3. Sterility in Man, 497 

4. Sterility in Woman, 498 

XIV. DISEASES OF THE FEMALE ORGANS OF GENERATION. 

Pruritus of the Vulva, 499 
Inflammation of the Vulva, 500 

1. Simple Vulvitis, 500 

2. Gangrenous Vulvitis, 500 

3. Follicular Inflammation of Vulva, 500 

4. Pudendal Erythema, 501 

Infantile Leucorrhoea, 501 



X CONTENTS. 

XIV. DISEASES OF THE FEMALE ORGANS OF GENERATION (con- 
tinued) : 
Tumors of the Vulva, 502 

1. Encysted Tumors, 502 

2. Fibrous Tumors, 503 

3. Warty Growths, 503 

4. Abscesses of Labia, 503 

5. Hypertrophy of Labia, 503 

6. Pudendal Hematocele, 503 
Corroding Ulcer of the Vulva, 504 
Cancer of the Vulva, 504 

Vascular Tumors at Orifice of Urethra, 505 
Diseases of the Clitoris, 505 

Nymphomania, 505 
Diseases of the Vagina, 506 

1. Occlusion, 506 

2. Vaginismus, 506 

3. Acute Inflammation of Vagina, 507 

4. Chronic Inflammation of Vagina, 508 

5. Prolapsus of the Vagina, 509 

6. Vaginal Tumors, 511 

Mucous Cysts, Fibrous Tumors, Polypus of Vagina, 511 
Diseases of Menstruation, 511 
Anienorrhoea, 512 

1. Retention of Menses, 512 

2. Suppression of Menses, 512 

3. Vicarious Menstruation, 513 
Dysmenorrhoea or Painful Menstruation, 513 

1. Neuralgic Dysmenorrhoea, 513 

2. Congestive Dysmenorrhoea, 514 

3. Mechanical Dysmenorrhoea, 516 
Menorrhagia, 518 

Inflammation of the Uterus, 520 

1. Acute Metritis, 520 

2. Subacute and Chronic Metritis, 522 

3. Chronic Catarrh of the Neck of Uterus, 524 
Ulceration of the Neck of the Uterus, 525 

1. Simple Ulcer of the Neck, 527 

2. Irritable or Inflamed Ulcer, 527 

3. Rodent Ulcer of Neck, 528 

4. Syphilitic Ulceration, 529 
Uterine Catarrh or Endometritis, 529 
Hysteria, 531 

Uterine Haemorrhage, 534 
Tumors of the Uterus, 534 

1. Fibroid Tumors, 535 

2. Polypus of the Uterus, 536 

3. Cysts of the Uterus, 536 
Cancer of the Uterus, 537 
Displacement of the Uterus, 538 

1. Prolapsus and Procidentia, 539 

2. Retroflexion and Anteflexion, 540 

3. Retroversion and Anteversion, 541 

4. Inversion of the Uterus, 541 

5. Subinvolution of the Uterus, 542 
Disease of the Ovaries, 542 

1. Acute Inflammation of Ovary, 543 

2. Chronic Inflammation of Ovary, 544 

3. Ovarian Tumors, 545 

4. Ovarian Displacement, 547 

5. Dropsy of Fallopian Tube, 548 



CONTENTS. XI 

XIV. DISEASES OF THE FEMALE ORGANS OF GENERATION {con- 

tinued) : 
Leucorrhcea, 548 
Pelvic Hematocele, 543 

Inflammation of the Cellular Tissue of the Pelvis, 549 
Change of Life, 550 

XV. DISEASES OF THE BREAST. 

Inflammation of the Breast, 586 
Abscess of the Breast, 587 
Diseases of the Nipple, 588 
Neuralgia of the Breast, 589 
Diminished Secretion of Milk, 590 
Excessive Secretion of Milk, 592 
Hypertrophy of the Breast, 592 
Tumors of the Breast, 592 

1. Lacteal Tumor, 593 

2. Fatty Tumor, 593 

3. Fibrous Tumor, 594 

4. Hydatid Tumor, 594 

5. Glandular Tumor, 594 

6. Mucous Cysts, 595 

7. Cancerous Tumor, 595 

XVI. DISEASES OF THE EYE AND EAR. 

Variations in Sight, 597 

1. Emmetropia, 597 

2. Myopia, 597 

3. Presbyopia, 598 

4. Asthenopia, 598 

5. Astigmatism, 598 

6: Color Blindness, 598 

7. Hvpermetropia, 599 

8. Amblyopia, 600 

9. Diplopia, 600 
10. Hemiopia, 600 

1 1. Hemeralopia, 600 

12. Nyctalopia, 600 

13. Photophobia, 600 

14. Mydriasis, 601 

15. Mvosis, 601 

16. Muscae Volitantes, 601 

17. Protuberant Eyeballs, 601 
Diseases of the Evelids, 601 

1. Stves, 601" 

2. Ophthalmia Tarsi, 601 

3. Trichiasis, 602 

4. Ectropion, 6u2 

5. Entropion, 602 

6. Epiphora, 603 

7. Ptosis, 603 
Ophthalmia, 603 

1. Infantile Ophthalmia, 603 

2. Common Acute Ophthalmia, 604 

3. Purulent Ophthalmia, 605 

4. Gonorrheal Ophthalmia, 606 

5. Tubercular Ophthalmia, 606 

6. Granular Ophthalmia, 607 

7. Rheumatic Ophthalmia, 608 

8. Catarrhal Rheumatic Ophthalmia, 608 

9. Sympathetic Ophthalmia, 608 
10. Ptervgion, 609 



Xll CONTENTS. 

XVI. DISEASES OF THE EYE AND EAR (continued) : 

Diseases of the Cornea, 609 

1. Acute Corneitis, 609 

2. Gouty, Syphilitic Keratitis, 609 

3. Opacities of the Cornea, 610 

4. Ulcers of Cornea, 610 

5. Conical Cornea, 610 

6. Arcus Senilis, 610 
Diseases of the Iris, 610 
Different Forms of Iritis, 610 
Inflammation of the Choroid, 612 
Retinitis, 612 
Cataract, 613 
Glaucoma, 614 
Amaurosis, or Blindness, 615 
The Lachrymal or Tear Duct, 617 

1. Kerophalmia, 617 

2. Ephiphora, 617 

3. Closure of Puncta Lachrymalis, 617 

Squintii 

4. Cancer, 619 
The Ear, 619 
Disease of the Ear, 619 
Inflammation, External Meatus, 620 

Membrana Tympani, 620 

Otorrhcea, 622 
Hemorrhages from Ear, 624 
Polypus and Growths in Ear, 624 
Relaxation of the Membrana Tympani, 625 
Diseases of the Eustachian Tube, 625 

1. Obstruction of the Tube, 625 

2. An Open Condition of the Tube, 626 
Tinnitus Aurium, or Noises in the Ear, 626 
Auditory Vertigo, 626 

Otalgia and Earache, 627 
Deafness, 628 

1. Rheumatism of the Ear, 628 

2. Gout of the Ear, 629 

3. Nervous Deafness, 629 

XVII. DISEASES OF THE SKIN AND CELLULAR TISSUE. 

Diseases of the Skin, 630 
Exanthemata, 630 

1. Erythema, 631 

2. Roseola, 631 

3. Urticaria, 632 
Haemorrhage, 633 
Purpura and Scurvy, 633 
Vesiculse, 633 

1. Sudamina, 633 

2. Eczema, 634 

3. Herpes, 635 
Bulla?, 635 

1. Pemphigus, 636 

2. Rupia, 636 
Pustule, 636 

1. Ecthyma, 636 

2. Impetigo, 637 
Parasitici, 637 

1. Tinea Tonsurans, 637 



CONTENTS. Xlll 

XVII. DISEASES OF THE SKIN AND CELLULAR TISSUE (continued) : 

3. Tinea Decalvans, 640 

4. Tinea Sycosis, 640 

5. Tinea Versicolor, 640 
Papula?, 641 

1. Lichen, 641 

2. Prurigo, 642 
Squamous or Scaly, 643 

1. Lepra or Psoriasis, 643 

2. Pityriasis, 644 

3. Ichthyosis, 644 
Tuberculse, 644 

1. Acne, 644 

2. Lupus, 645 

3. Keloid, 647 

4. Elephantiasis, 647 
§. Molluscum, 647 

6. Framboesia, 647 

7. Vitiligo, 648 

8. Leucoderma, 648 
Burns and Scalds, 648 
Chilblains or Frost-bite, 649 
Boils or Carbuncles, 650 
Alopecia or Baldness, 651 
Ulceration, 652 

1. Healthy Ulcer, 652 

2. Inflamed or Irritable Ulcer, 652 

3. Indolent or Chronic Ulcer, 653 

4. Tubercular Ulcer, 653 

5. Varicose Ulcer, 654 

6. Fistulous Ulcer, 654 

7. Phagedenic Ulcer, 655 

8. Hospital Gangrene, 655 

9. Anthrax, Malignant Pustule, 655 
Inflammation of Matrix of Nail, 656 
Ingrowing Toe-nail, 656 

Sweaty Feet and Hands, 656 
Foot Disease, 657 
Warts, Corns, etc., 658 

1. Warts or Vegetations, 658 

2. Moles, 658 

3. Corns, 658 

4. Bunions, 658 

5. Malignant Ulceration, 659 
Chapped Hands, 659 

Scabies, or Itch, 659 

Lousiness, 660 

Inflammation of Cellular Tissue, 660 

Tumors, 661 

1. Fatty Tumor, 662 

2. Fibroid Tumor, 662 

3. Colloid or Gelatinous Tumor, 663 

4. Cartilaginous Tumor, 663 

5. Osseous Tumor, 663 

6. Glandular or Sebaceous Tumor, 663 

7. Cystic Tumor, 663 

8. Melanotic Tumor, 663 
Injuries, 664 

Wounds, 665 
Haemorrhage, 667 



XIV CONTENTS. 

XVIII. DISEASES OF THE MUSCLES, TENDONS, BONES, AND 

JOINTS. 

Diseases of Muscles and Tendons, 668 

1. Myositis, 668 

2. Myalgia, 668 

3. Muscular Atrophy, 669 

4. Hypertrophy of Muscles, 670 

5. Kupture of Muscles and Tendons, 670 

6. Strains, 670 

7. Inflammation of Tendon, 671 

8. Tumors on Tendons, 671 

9. Ganglion, 671 

10. Inflammation of Bursse, 671 
Cramps, 671 
Diseases of the Bones, 672 

1. Periostitis, 672 

2. Ostitis, 673 

3. Caries and Necrosis, 674 

4. Atrophy of Bone, 675 

5. Hypertrophy of Bone, 675 

6. Exostosis, 675 

7. Mollities Ossium, 675 
Rickets, 676 

1. Psoas Abscess, 677 
Spina Bifida, 677 
Spinal Curvature, 678 

1. Lateral Curvature, 678 

2. Posterior Curvature, 679 

3. Anterior Curvature, 680 
Diseases of the Antrum, 681 

J. Abscess of Antrum, 681 
. 2, Dropsy of the Antrum, 681 

3. Tumors of the Antrum, 681 
Fracture, 682 

Non-Union of Bone, 684 

Compound Fractures, 685 
Special Fractures, 685 
Disease of Joints, 689 

1. Acute Synovitis, 689 

2. Chronic Synovitis, 690 

3. Abscess in Joints, 690 

4. Chronic Gout and Rheumatism, 690 

5. Tubercular Disease in Joints, 691 

6. Anchylosis, 692 
Dislocations, 693 

XIX. CHILD-BIRTH. 

Conception, 695 

Pregnancy, 695 

Signs and Symptoms of Pregnancy, 696 

Development of the Foetus, 698 

Vomiting of* Pregnancy, 699 

Depraved Appetite, 700 

General Symptoms of Pregnancy, 701 

Convulsions, Epileptic J^its, Chorea, during Pregnancy, 701 

Irritable Bladder, 701 

Menstruation during Pregnancy and Lactation, 702 

Albuminuria or Dropsy in Pregnancy, 703 

Pruritus of the Vulva, 703 

Eruptions and Excoriations about Pudenda, 703 

Piles, Swelling of Labia, Varicose Veins, Cramps, 704 



CONTENTS. XV 



XIX. CHILD-BIRTH (continued): 

Spurious Pregnancy, 704 

Deformities and Mutilations, 705 

Labor, 705 

Retention of the Placenta, 711 

Hour-Glass Contraction, 711 

After-Pains, 714 

The Forcing- Powders in Labor, 714 

Abortion, 715 

Missed Abortion, 715 

Foeticide, 716 

Ulceration of the Internal Cavity of the Uterus, 717 

Hematocele, 717 

Cancer a Sequel of Abortion, 717 

Blood Tumor of the Labia, 717 

Inflammation of Vagina, 718 

Puerperal Fever, 718 

Laceration of Perineum, 718 

Vesico-Vaginal Fistula, 718 

Recto- Vaginal Fistula, 719 

Puerperal Mania or Madness, 719 

Puerperal Convulsions, 720 

Puerperal Peritonitis, 720 

Milk Fever, 720 

Miliary Fever, 720 

Rupture of the Uterus, 720 

Aching Kidney, 721 

Coccyodvnia, or Neuralgia of the Kidney, 721 

Painful Sitting, 722 

Other Morbid States Co-existent with Child-birth, 722 

XX. THE CHILD— ITS DISEASES, 723 

The Child, 723 

Management of the Infant at Birth, 725 

Peculiarities of the Infant, 727 

Peculiarities of its Diseases, 728 

Diagnosis of Infantile Diseases, 729 

Diseases of Infants, 733 

Inflammation of the Umbilicus, 733 

Swelling, or Milk in the Breasts, 733 

Retention of the Meconium, 733 

The Yellow Gum, 733 

Asphyxia, or Still-born, 734 

Excoriations, Chafing, 736 

Non-expansion of the Air-cells of the Lungs, 736 

Cephalsematoma, 736 

Convulsions of Infancy, 737 

Nine-day Fits, 737 

Imperforate Anus, 837 

Hide Bound or Sclerema, 738 

Hiccoughs, 738 

Infantile Mortality, 738 

Infantile Syphilis, 739 

Teething, 740 

Difficult Dentition, 741 

Aphtha?, or Nursing Sore Mouth, 743 

Weaning Brash, 743 

Malformation and Deformities, 743 

The Nutrition of the Infant, 746 

The Child, its Care and Culture, 750 



XVI CONTENTS. 

XXI. EMERGENCIES AND THEIR TREATMENT. 

Haemorrhages, 751 

Contusions, Ecchymosis, 752 

Wounds, 752 

Foreign Bodies in the Air-Passages, 753 

Foreign Bodies in the Nose, 753 

Foreign Bodies in the Ear, 753 

Foreign Bodies in the Eyes, 754 

Burns and Scalds, 754 

Shock or Collapse, 754 

Sunstroke, 754 

Retention of Urine, 754 

Dog or Snake Bite, 754 

Lightning, 754 

Insensibility from Various Causes, 755 

Asphyxia, 757 

Asphyxia from Drowning, 757 
Asphyxia from Strangulation, 758 
Asphyxia from Poisonous Gases, 758 
Methods of Treatment, 358 
For Asphyxia, 758, 759 
Intense Cold, 761 
Syncope, 761 
Narcotic Poisons, 761 
Poisons, 762 

i. Inorganic Poisons, 762 
Acids, 762 
Alkalies, 763 
Gases, 763 
Metals, 764 
ii. Organic Poisons, 767 
Vegetable Acids, 767 
Oils, 767 
Alcohol, 767 
Volatile Oils, 768 
Irritant Vegetable Poisons, 768 
Narcotic Poisons and Non-narcotic Poisons, 769 
Poisonous Mushrooms, Sausages, 770 
iii. Animal Poisons, 770 
Poisonous Fish, 770 
Poisonous Serpents, 771 
Venomous Insects, 771 
Post-Mortem, 771 
Death Causes, 771 
Rigor Mortis, 772 

XXII. REMEDIAL AGENTS, 773. Embracing five hundred original pre- 

scriptions never before published ; also articles on Diet, Bathing, 
Anaesthetics, Electricity, Mineral Waters, and Climate, etc., etc. 



INTRODUCTION. 



■§# HE PRESENT WORK is designed as a manual for families 
in cases of emergency, when the ordinary family physi- 
cian's services cannot he promptly obtained. It will be 
obvious to the reader that it is written in the plainest language, 
and everything like prolixity has been avoided, the whole ob- 
ject of the author being to instruct the reader in a knowledge 
of disease. There has been no divergence from this point. 
The general land-marks of a good, common-sense treatment of 
disease are laid down, devoid of all technicalities and clap-trap. 

The question will be asked, what kind of Practice is it? We 
answer, simply an American, for we regard medicine as an in- 
exact science, whose object is to mitigate human suffering, and 
aid in the prolongation of life. We recognize no creed, or sys- 
tem, or cure, or pathy, or ism in medicine; it is a unit, a whole, 
like other sciences ; it recognizes disease as a deficiency of life, 
and takes hold of everything as curative that aids in its re- 
moval. Medicine has a true benign spirit — seeks and absorbs 
all knowledge, every kind of means or appliance to aid nature 
in the cure of disease. 

Medical science in our country has suffered a tremendous de- 
gradation. A physician does not command the honor and re- 
spect that is awarded him ill other countries; neither is he the 
recipient of brilliant rewards, nor does his talent, however great, 
engender that warm recognition and appreciation. This is 
due, in a great measure, to the systems, cures, pathies, and 
isms that have been permitted to grow, like poisonous weeds, 
and have received the countenance of a portion of the profes- 
sion. It is due also to the quality and calibre of the graduates 
that have been turned out, one-half of whom are a burlesque 
on knowledge, science, and truth. It is due to a pretended di- 
vinity in medicine, and to its arrogant subdivision into sects, or 
so-called schools, got up by rogues, knaves, and illiterate men 
who never received a medical education, but simply took to 
medicine, and became its ostensible teachers because they could 
not earn a livelihood at their trade. It is due also to the fact 
that noted charlatans all over the country own medical schools, 
publish trashy journals, and turn out biannually ignorant gradu- 



18 INTRODUCTION. 

ates to prey upon the community; men and women who know 
nothing of disease or its cure, or the action of drugs. This 
medical disgrace, or odium, or stigma has been fostered, fed 
and kept alive by a corrupt, avaricious medical press, for the 
sake of the cash paid for their advertisements. 

Times are changing, and the people are beginning to look 
upon those ignorant charlatans with disgust. In no country 
in the world do we need a higher grade of medical education 
than in our own. We practice among a non-indigenous race 
of people, mixed races, living and often blending together, each 
having their own diseases, or creating, or aggravating, or in- 
tensifying all grades of morbid action, the management of 
which requires greater skill, keener penetration, and higher 
scientific attainments in the physician, and in spite of all this, 
medical education is at its lowest ebb. Indeed, there is only 
one or two schools in which a first-class education can be pro- 
cured. As a rule medical teachers are utterly incompetent. 

From the highest to the lowest, the base effrontery of the char- 
latan is either directly or indirectly patronized, and to some 
extent believed in. The serpent is warmed, fed, and nourished 
by the orthodox, and he turns round and stings them. Char- 
latanry should be crushed, nay, stamped out, and educated men 
should divest science of its mystery and show to the world that 
medicine is not a science that admits of inspiration or specifics, 
and that the practice of the healing art is not one that can be 
acquired by the unlearned. There can be no specific or sys- 
tem, or cure,, or charm, or nostrum, or sugar globule, or specific 
tincture known to the true physician ; his calling consists solely 
in the rational study and treatment of disease on common-sense 
principles. 

A true, just, and truthful conception of medical science 
must bar the recognition of systems or cures of any class or 
description. The art of healing is not a sect or system, and 
never can be made one. It is simply an intelligent common- 
sense application of the laws of health, the proper adaptation 
of remedies to aid nature to a renewal of life in disease. The 
symptoms and pathology of a malady are studied, with a view 
to the acquisition of precise knowledge as to its nature, cause, 
and rational treatment. In our investigation of disease, we 
travel over the boundary line of death and explore the cada- 
ver to ascertain the effect of the morbid state on the organism, 
and to elicit the organic causes. We test the powers, analyze 
the properties of drugs, and we scrutinize and make careful 
trial of methods of treatment, to obtain an accurate acquaint- 
ance with their nature and action. In short, we adopt every 
means to render the principles and practice of our art rational. 
This is our duty; we do not give any countenance to humbug 



INTRODUCTION. 19 

triturations, specific medication, sugar-globulism in medicine, 
as they are frauds ; nothing in them. We have no friendliness 
to quacks, charlatans ; we believe in sincerity and truth ; Ave 
hate humbug in all its forms, and detest wrong and untruth- 
fulness. 

We have no friendship for the Nihilist in Medicine, nor for 
the pathist, or the ism, or the layer-on of hands, or the inspired. 
We have a profound contempt for such. Out of the eighty 
thousand physicians in these States, one-half are unmitigated 
frauds or impostors and consist of botch barbers, reporters, 
carpenters, coal operatives, swindlers; uneducated asses, vipers, 
living on the credulity of the people. Those charlatans not 
only do a great injustice to themselves, but injure the entire- 
profession of which they seek to become members, although 
they are mere fungi or excrescences. 

Designations, as implying the adoption of special modes of 
treatment, are simply trade-marks for gain, and are ojDposed to 
the dignity of the profession. What educated man can talk 
with a fool who argues that a grain is, for potency, nothing, 
but the decillionth part of a grain is dangerously powerful? 
Specific medication is a bastard of the above monstrosity; a 
discreditable and absurd dogma — trade-marks, by which infa- 
mous scoundrels catch trade, patronage, and above all, fill 
their averacious pockets. They hold to it like so many vul- 
tures, because it pays. Those charlatans will blow and brag, 
introduce speculums and uterine sounds, massage the uterus, 
coin new names for maladies, invent new fashions and maltreat 
their patients, and by their diabolical villainy they even con- 
found and mix up drugs, by manufacturing new names, as 
essential tinctures, specific tinctures, concentrated tinctures, 
mother tinctures — all creations of their own puny, brains — a 
mercenary scheme to swindle the profession. 

Medical matters, so degraded and mixed up, could. easily be 
rectified bv the enactment of a United States registration law. 
for the protection of the lives and health of the people, in which 
systems should be unknown ; a board of examiners to consist 
exclusively of naval surgeons, in each State; all physicians 
under twenty years' practice to be examined in medicine, sur- 
gery, and midwifery; under ten years, in all the branches; the 
diplomas of all schools to be ignored, no questions, even, asked, 
as to whether he is a graduate or not — the test to be ability, 
irrespective of any worthless document. In this way the entire 
country can be thoroughly purged of the reptiles that are now 
so prolific, and all inferior schools stamped out for want of pa- 
tronage. Much good could be effected by medical journals re- 
fusing the advertisements of all charlatan institutions, and by 
the drug trade utterly prohibiting the sale of their nefarious 



20 INTRODUCTION. 

remedies. One energetic movement, and the medical profession 
of this country can at once elevate itself to the same rank and 
status as that of other civilized nations. 

-X- -X- -X- -X- -x- 

As this work treats exclusively of the diseases of the Cauca- 
sian, it may be necessary to make a few remarks upon the sub- 
ject of races, as our government is an anomaly on the earth, 
in so far as we have an older, distinct, and highly inferior race 
voting with and engaged in ruling a superior. Besides, the 
very fact of a distinct race living in close proximity deteriorates 
both, and aggravates with profound intensity all contagious 
diseases passing from the one to the other. The subject is of 
vital importance to us as a nation — this blending or mingling 
of races. Medical men are afraid either to write or speak on 
the subject — afraid of persecution, afraid of not being popular; 
but we boldly assert it that there is no educated physician in 
this or any other country who can believe in the unity of the 
human species. That there is also a far higher antiquity to 
some races of men than what is recorded in the Mosaic record. 
Indeed, it can be easily demonstrated that man existed centu- 
ries before Adam. But although this is the case it in no way 
contradicts the inspired word. 

There are distinct races of men ; the living witnesses are be- 
fore us in the Mongolian, the Negro, the Malay, the Inclo- 
American, and the Caucasian — essentially different types of 
mankind; different in color, organism, construction, physiog- 
nomy, and blood. Besides the difference in complexion and 
physiognomy there is a marked variance in their anatomical 
and physiological structure, an incomparable, impassable dif- 
ference in bones, brain, nerves, senses, vessels, glands, and in 
language, which latter alone, when considered, makes a dis- 
tinction, a perfect line of demarkation, so that neither race can 
be traced to a common source or origin. One group or family 
of languages form a class known as the inflectional, and are dis- 
tinguished from all others on the globe as the only languages 
that are adapted to and possess a literature, a science, art, pro- 
gress. This is the property of the Caucasian, the sole civiliz- 
ing race in the world, and was doubtless taught to him in the 
( harden of Eden. The other groups of languages are monosyl- 
labic, and are destitute of all grammar; the nouns have no 
number, declension or cases, and the verbs are without conju- 
gations, moods, tenses or persons. 

The variety of races is no mystery; each is a separate, dis- 
tinct creation, for a gradation of species is absurd and incon- 
sistent. A changing, a negation, an amalgamation, is death 
and extinction to all concerned in the effort; a change from 
black to white an absolute impossibility. 



INTRODUCTION. 21 

We have abundant evidence to show that the different races 
existed four thousand years ago, as distinct as they are to-day ; 
accurate likenesses on monuments and other historical evi- 
dences are prolific and available on the subject. Incontroverti- 
ble evidences — geological, archeological, philological, physio- 
logical, psychological, anatomical, and historical — all tend to 
establish the proposition, that of all the distinct races of men 
which are now and which have been on the earth from time 
immemorial, and inhabited its respective sections, the Caucasian 
was the last to make his appearance — a masterpiece of creative 
mechanism, made out of God himself. The record of Moses 
does not in any way contradict the existence of other races be- 
fore Adam. All attempts to trace the different races in a de- 
gradation from Noah result in glaring failure. It is well known 
that both the Chinese and African nations existed centuries 
before Adam. 

There can be little doubt but that the intermarriage of the 
Adamite daughters with the adjoining races was the real cause 
of the flood. God foresaw the terrible results of incompati- 
bility of races — that the stock produced was inferior to either 
of the mingling parents — derogatory to the welfare of His peo- 
ple, and would tend to extermination. 

The Bible should be regarded as the history of a particular 
race — the Adamite. His creation, his fall, his restoration to 
paradise, are the themes of holy writ. Salvation is proclaimed 
to the heathen by faith in Christ, and as it is free and bounti- 
ful enough, other races are permitted to participate in its 
benefits. 

Truth, in whatever department of science it appears, cannot 
be contradictory of Revelation. There oftentimes may be an 
apparent antagonism, but it is not real. When the} 7 are not 
reconcilable either Revelation or science is misunderstood. 
The word of divine truth stands sure. Scientists may err, but 
the ultimate deductions that we, the Adamites, are to infer, 
are, that the mixture of races does not produce a true, hybrid 
condition, but something analogous to it. It degrades the bio- 
plasm of both races concerned, by producing stock highly tu- 
bercular; so much so that it will inevitably terminate in the 
utter extinction of any given race concerned or implicated, and 
as the mixture of races was the cause of the flood, so it will, if 
persisted in by our people and government, infallibly produce 
a condition of national decadence and ultimate annihilation of 
all the parties. Words fail to express the supereminent de- 
gradation inflicted on any race by a deterioration of its origi- 
nal properties, its organic elements. 

If space permitted, we could easily show a perfect distinction 
of races in other points, as construction, craniological develop- 



22 INTRODUCTION. 

merit, difference in bones, senses, etc., and their perfect incom- 
patibility. We have an excellent national example in Mexico, 
where we have the noble Spaniard coupling with the aborigi- 
nal Indian, giving us a race much inferior to either of the 
mingling parents; a race that must inevitably die out. 

Marriage, to give a good stock, must be consummated within 
the race. And marriage among the Caucasians of individuals 
of the same temperament, identical in color of hair, skin, eyes, 
conformation ; or persons related by consanguinity, should be 
prohibited by law, as they entail on their offspring tubercular, 
an element of deterioration and death within the races. Still, 
with all a morbid race cannot be established in the true sense 
of the term, for the evil cures itself by non-procreation. No 
sensible deterioration in size, beauty of form or expression, can 
take place, for the moment the boundary line is reached the evil 
cures itself in non-procreation, so that the Caucasian to-day is 
a perfect fac-simile of our prototype, Adam. 

It seems to be a difficult matter to get the hide-bound, or so- 
called orthodox Christians to appreciate the essential differ- 
ence of races, but as they are distinct in their anatomy, so are 
they different in all other attributes; their sympathetic sys- 
tems are imperfectly developed ; that is, it exists in a more ru- 
dimentary condition ; consequently, they are incapable of taking 
on the diseases of the white man. It is impossible for them to 
take yellow fever, acute laryngitis, pneumonia, carditis, typhoid 
fever, &c., and if it is true that the soul of the Caucasian is lo- 
cated in his great sympathetic, and Iris moral nature there de- 
veloped, where could there be a more decided element of dis- 
parity of race. The very senses and their organs are different, 
being more highly developed in the colored race than in the 
white. 

This distinction of race comes home to us most strikingly in 
the aggravation of the types of all our diseases, when two or 
three dissimilar races are living in close proximity. Suppose 
the child of white parents contracts measles, scarlatina, small- 
pox, from the convalescing child of the negro or mongolian ; 
the so contracted disease, even though of a mild form in the 
colored, will become virulent and malignant in the white, and 
vice versa. Let a white man contract a gonorrhoea from a 
colored woman, and he has something that no known drug 
will stamp out for months or years. The fact of two antago- 
nistic races residing in close proximity is detrimental to the 
prosperity, health, happiness, longevity, and freedom from dis- 
ease of either race. 

-X- -X- -X- -x- -x- 

All physiologists and naturalists agree in asserting that the 
sexual instinct is much stronger in the male than in the 



INTRODUCTION, . 23 

female, so this fact must be accepted. In countries in which 
women keep their normal sphere, the number of male births 
exceed the female by five or six per cent. But that represents 
the children born alive, if we take the miscarriages and still- 
born, the male rate exceeds the female forty or fifty per cent. 

The germ cell, or female, transmits the form and general 
hereditary qualities of a race, while the sperm cell, or male, 
introduces the variations which fit the race to survive under 
new conditions of life, the sex being determined by the greater 
vigor and maturity, or greater fitness for survival in either 
parent. Where the ordinary conditions of life are uniform and 
constant, the germ cell will predominate and females be pro- 
duced in excess; where women leave their sphere and take on 
the strong-minded element the offspring are all females; where 
the conditions of life are variable or injurious to the race, the 
acquired vigor in the struggle for existence, the sperm cell will 
predominate, and an excess of males be the result, In the 
civilized condition the two sexes are of equal value, inclining 
to the side of the male, provided each keeps its proper sphere. 
Austria and Great Britain afford us an example in which the 
two sexes are on an equal footing or basis, and we find on 
examination of their birthrate, that there are born one hundred 
and ten males to one hundred females, which shows an absolute 
excess of male births, and this excess occurs at the earliest and 
most vigorous portion of married life. 

The sex rate, also, seems to be largely dependent on the rela- 
tive maturity of the parents, as well as their vigor, the more 
mature parent being the most potent in determining the sex : 
the sex being the same as the most mature parent. The fol- 
lowing figures exhibit the proportion of male births in one 
hundred females : 

Father younger than the mother, . ' . 90 

Father and mother of equal age, .... 91 

Father older by one to six years, .... 103 

Father older by eleven to sixteen years, . . . 147 
Father older by eighteen or more, .... 175 
As females attain to maturity five years earlier than males, it 
is probable, from the above table, that with a difference of age 
of five years in favor of the father, the two sexes would be 
about equal. 

The hereditary physical and mental qualities are trans- 
mitted by the female, and that variation and adaptability to 
new conditions of life are introduced by the male; we do not 
wish to imply that the germ cell is not modified by external 
conditions, but only that it is subject to fewer causes of varia- 
tion — that it possesses a strong inherent disposition to resist 
change, and that it will be destroyed rather than accommodate 



24 INTRODUCTION. 

itself to any marked changes in the condition of life. It is most 
tenacious of vitality, indeed we see the female embryo resisting 
violence of all kinds, action of drastic drugs and constitutional 
taints in the parents, living in spite of danger and disease. 

From statistics of the two countries mentioned (for our own 
are not reliable, being full of the strong-minded element, which 
by and by will render us a nation of girls) it is probable that 
the proportion of births, marriage being properly regulated by 
age, should be the proportion of three males to two females, 
and this number would be a typical family, which would 
admit of the sacrifice, not necessarily the destruction of one 
male, to accommodate the race to the ever changing condition 
of life, and to assure the constant accession of fresh vigor and 
maturity. The wealthy, living under the most favorable con- 
ditions of good living, of natural and sanitary surroundings, no 
struggle, have the two sexes equal, females slightly predomin- 
ating, in embryonic and infantile life, boys do not possess 
near the vitality of girls, which may account for the unusual 
destruction of males at birth, their heads are larger and the 
diseases incidental to childhood always proves more fatal to 
male than female children. Races being distinct creations, are 
antagonistic to each other, so to preserve the vigor and vital 
integrity of a given race, its members must marry within it, 
for if they mix with other races, they implant deterioration, 
disease, and death on their offspring. . 

Individual members of the Caucasian race must maintain 
and utilize their vigor, and in order to do that should not 
marry one of similar temperament and physique, nor in similar 
conditions of life ; a literary man never should marry a literary 
woman, nor a tailor a seamstress. Cross fertilization within 
the race produces the best stock. There should be no in and 
in breeding in temperment, nor in similar conditions of life, 
far less than among blood relationship. 

There is a growing error in the public mind on maturity. 
It is a great error to suppose that puberty in either sex is a sign 
of fitness for marriage. Growth and reproduction cannot go 
on beneficially together, reproduction being a diversion of 
growth or development in a new direction, namely, from the 
individual to the race. Men do not cease to grow until they 
are twenty-five, women till they are twenty-one, according to 
the good or bad nurture they receive, the best nourished at- 
taining maturity first. It is obvious that those ages are the very 
earliest that marriage should be consummated, and, indeed, 
the father should be much older, if male children are desired. 
The best way of increasing the male births is to keep women 
in their proper sphere and direct our energies to the preserva- 
tion of males at birth. This has been done to some extent by 



INTRODUCTION, 25 

the grand improvements in the art of midwifery, but the mis- 
chief lies in the disproportionate size of the head of the male 
foetus and the mother's pelvis, which has been constricted by 
dress, tight lacing and abnormal mental culture. For the 
curve of the sacrum and crook of the coccyx is a true index 
of the mental culture of the mother; the higher the one the 
greater the other. It is impossible to estimate the great loss 
the race sustains in superior and mental qualities by this un- 
necessary destruction of its finest products. 

At birth, in children born alive at full period, the average 
length of male infants is nineteen and one-half inches, and of 
females eighteen and one-quarter inches ; while their average 
weights are: males, seven and one-half pounds; females, six 
and one-half pounds. The waste of male children, owing to 
the large size of their heads and the contracted condition of 
the modern civilized female pelvis is immense. The remedy 
for this is apparent, and to be found in direct improved devel- 
opment of the girl's physical education and dress, an avoidance 
of the defects of civilization and a more careful guarding of the 
sexes in marriage. 

The average stature of the American woman is five feet two 
inches to five feet three inches, and of man five feet seven 
inches to five feet eight inches. The difference between the 
two sexes being four or five inches ; and as stature carries with 
it other relative proportions of the body, it is probable that if 
these limits were observed all through the scale of heights 
there would be fewer male still births. It was at one time 
thought that the intellectual struggle going on caused an in- 
creased development of the brain in children and consequently 
larger heads in male children, but this has been found to be 
erroneous, for ever since the introduction of woman's rights 
movement the heads of boys and consequently men have be- 
come notoriously small, and the male children of such women 
effemiate, so that the recent impetus given to the so-called ed- 
ucation of girls and the employment of women in intellectual 
pursuits is adding td the difficulty, and if it does not end by 
producing sterility, as is probable, or in the birth of female 
children only, which is still more probable, it must at least tend 
to the destruction, more and more, of males at birth. It is 
obvious that whether we consider the health and happiness of 
the individual or the future prosperity of the race, that the 
healthy physical development of girls is of first and supreme 
importance. The boy is father of the man, the girl is the 
mother of the race, for to her is entrusted the hereditary char- 
acteristics of our forefathers. She has the means of transmit- 
ting them and indirectly of acclimating and accommodating 
the race to new and varying conditions of life. 



20 INTRODUCTION. 

The reproduction of characteristics resembling those of the 
father in the son, is in a large measure effected through the 
agency of the female where there is. a strong affection on the 
part of the mother for her husband; his likeness, physical and 
mental is impressed on the son through the agency of the 
mothers' psychic force. The feeling, impulse or sentiment 
which pervades the mind of the mother controls and influences 
the development of the child. Peculiarities of feature and 
form that impress her powerfully, whether with admiration or 
abhorrence are reproduced in the offspring, and if her mental 
conditions be particularly strong, the impression maybe trans- 
mitted in exaggerated intensity. These things happen in 
male children, which are specially the mother's. The likeness 
which female children bear to the male parent is the direct 
effect of reproduction in kind. The maternal influences are 
less evident in a female than in a male offspring. Perhaps a 
good view to take of the subject would be the following : sex is 
the result of an arrest or repression of the force of development 
in the case of the female. The male of every family in the 
animal kingdom is the best and fullest specimen of develop- 
ment, having regard to the purposes and habits of life of the 
species, class or family. The arrest in point of development 
which characterizes the female, has nothing in common with 
immaturity, and is no proof of inferiority. It is simply a 
repression of the formative force, and the physical result of 
that repression is a perpetual effort to develop or reproduce. 
The force arrested in the individual gathers intensity and ex- 
presses itself in a perpetual and characteristic longing to pro- 
duce a perfect animal. The perfection denied or inhibited in 
the individual is sought for in the progeny. 1 1 ence, the natural 
tendency of the female to produce male children, and as a 
necessary result most of the children born are males. 

It is not a question of ardency in the two sexes, but of the 
direction or force of intention or purpose of nature, that is the 
inner working of natural laws. The tendency of what is 
called ardency in the performance of this function is to neu- 
tralize or control the productive force of the female, and thus 
deteimine that arrest of development which results in female 
offspring. Here, again, there is no cmestion as to the compar- 
ative amount of ardency in the two sexes, because the ardency 
of the male may be dissipated by the extent of its activity so 
as to be in no instance dominant, or it may be restrained or 
intensified, and, therefore, when it acts, assert supremacy. 

The way constitutional strength comes into play, as it 
undoubtedly does in sex determination, is by giving vigor to 
the natural action of natural laws, not by changing the opera- 
tion of these laws, so as to make them non-natural. Through- 



INTRODUCTION. 27 

out the organic kingdom, we see nature preserving and devel- 
oping the germ cell, while on the other hand, we are con- 
stantly reminded of her lavish production and apparent waste- 
fulness of sperm cells. 

The function of the male is not one of production, hut 
fecundation. The laws governing the development of monsters 
are laws of development, rather than of procreation, and they 
come into play after conception. The natural tendency of the 
female is, if she does not exhaust her brain force, to produce 
male children in excess, and, as a result, when mothers live 
properly a large percentage of the children born are males, but 
let the child-bearing mother exhaust her mental powers as a 
teacher, preacher, astronomer, or other literary avocations, her 
children will be all females, and if there should occasionally be 
males, they will be effeminate, have small heads and feeble 
brains, and resemble girls in their actions. Woman may be 
more perfect in her anatomical construction than man, but her 
great sympathetic is merely rudimentary, so she needs a man 
to complete her component parts. The practice of women en- 
gaging in literary pursuits and learned professions is well 
enough, if they maintain celibacy; but if they ever marry and 
bear children, then they are sapping and deteriorating the ele- 
ments of national growth and vigor. 

Pathology is a term of frequent occurrence in the pages 
on diseases proper, and necessitates an explanation. Physiol- 
ogy is the science of healthy organic life; pathology, the 
science of the unhealthy or abnormal course of life contrasted 
with the normal. The division of vital action into normal and 
abnormal is superficially true, but it cannot stand as a defini- 
tion for the practical science of pathology, nor is it of value in 
treating diseases. "We know that the changes that take place 
in bones in youth and old age, and also in cartilage, lung, 
brain and other parts are in harmony with the dictates of 
nature, and are no more unnatural or pathological than the 
yellow leaf that falls from the oak in autumn, but if these 
senile changes are premature, then they are morbid or path- 
ological. A premature decay that brings the organism to an 
end is morbid — it may be general or operate upon one organ 
alone. The pathologist regards the body with its physiological 
relations with its surroundings, and marks the alterations that 
time produces. The physiologist appreciates the law of gain 
and loss, and regards the destructive process, as well as the 
formation. Life seems to depend upon changes going on in 
the atmosphere in which all living bodies are steeped — the 
burning of the fuel in oxygen supplies the forces necessary for 
living processes; we, therefore, though alive, are being con- 



28 introduction: 

stantly consumed. During so many years the body is under- 
going combustion or slow destruction, and this process occurs 
much more rapidly in some countries, than in others, and in 
some animals more than in others. An American burns out 
sooner or lives faster than his aboriginal in Britain. Why one 
creature should live longer, or burn out sooner than another is 
not clear; why, for example, should a dog be worn out in ten 
or twelve years, its limbs be stiff, its hearing impaired, its 
intellect obtuse and senile changes be discoverable in its brain 
and elsewhere, when a parrot may take a century for the pro- 
duction of the same destructive changes ? Why the tissues of 
the same composition, should wear out in one animal in ten 
revolutions of the earth, when it takes a hundred in another 
to destroy similar ones is not apparent. In man, if the 
destructive and reproductive changes are normally counter- 
balanced, the ordinary duration of life is reached. If the bal- 
ance is not kept, the destructive forces may be in the ascend- 
ency, and life may be shortened. If any of the ordinary sur- 
soundings, which are always exerting their influence upon us, 
as various kinds of food, air, water, moral and mental moods, 
be in any way depressing or noxious, they may lead to prema- 
ture death. Besides irregularities, inequalities and excesses are 
diseases of our own infliction. Truly man is surrounded by 
influences that tend to destroy him — forces within and with- 
out — agencies working to destruction, but there is a wonderful 
innate law of reparation. 

The law of acclimation, planting a race on a soil, and 
rendering it homogeneous is a wonderful faculty ofthe Cauca- 
sian and his adaptation to all its conditions and healthy rela- 
tions between them. The surroundings of highly civilized 
society and life acts with undue proportion in the production 
of disease. 

A very large number of diseases are due to the degradation 
of the living matter of our own bodies, the influence of de- 
pressed vital force, the influence of surroundings or of a spe- 
cific character. Specific diseases are thus produced, besides 
often due to micro-organisms from other organic bodies. We 
also see in addition to those abnormalities the spectacle of one 
animal preying upon another as in the case of the trichinae. 

There is a remarkable analogy in the origin or cause of dis- 
ease in plants, animals and man, affording a rich mine of sci- 
entific research still unexplored. 

-X- * # * # 

There is much truth in the law of reflex emanations of vital 
force becoming like each other when in close contact; of the 
strong imparting their vigor to the feeble, etc. In the use of 
physiology as a part of the science of medicine, we utterly 



INTRODUCTION. 29 

repudiate such, tricks and heresies as those of mesmerism or 
the fantasies of clairvoyance. 

In viewing the subject, we, for the sake- of convenience, divide 
man's nerve centres into three distinct brains, the cerebrum 
proper, the cerebellum medulla oblongata and spinal, and the 
great sympathetic. The principal ramification of the latter 
is over the viscera in the abdomen, the organs of chest and 
face. It is in the Great Sympathetic that the soul or moral 
nature of man's emotions, desires, affections, passions is lo- 
cated. Its principal ramification is over the spleen, left kid- 
ney, urinary and generative organs, viscera, heart, lower lobe 
of right lung, larnyx, and face. There is a lack of develop- 
ment of the great sympathetic in most women, hence their 
passions, though apparently strong, are evanescent, and they 
have a total exemption of such affections as acute carditis and 
laryngitis, idiopathic inflammation of brain, and are incapable of 
exercising the function of psychology. To be a good physician 
he must be a good psychologist, that is, understand the inner 
nature, heart and soul, of the patient. AVhatever may be the 
casual relations existing between mind and body, the mental 
part is not less real than the material and it plays an equally 
realistic part in the production and cure of disease ; in the 
eradication of constitutional morbid states and resistance to or 
assimilation of remedies. The practitioner who ignores the 
mind in his study of disease or disregards it in his plan of 
treatment would be throwing away his means and power. The 
healing art never could survive the sacrifice of the unseen, yet 
perceptible side of humanity in the sick chamber. Man, as an 
animal, is the physical outcome of protoplasm; as an immortal 
being, the outcome of Deity. The Caucasian man is identified 
by his moral nature or visceral brain which is but rudimentary 
in other races. This is strictly true as dissections can demon- 
strate. 

If emotions spring from the great sympathetic, as no doubt 
they do, a pathology of that must form an integral part of 
medicine. To ignore its phenomena in disease would be to lose 
our best symptoms, as the psychological conditions are often 
strongly marked. A physician must have knoAvledge of the 
soul, he must feel with finer senses, other pulses, and measure 
heats and chills which no thermometer can gauge. Each year 
progress in science gives new strength to the position and de- 
fines with increasing accuracy the place of the physician in 
advance of the dry and soulless philosophy which is accepted 
as scientific medicine. 

The body and soul are inalienable ; so in health, so in disease. 
The mental phenomena of life are the direct effect or reflexes 
of the physical state. 



30 INTRODUCTION. 

Of the mysterious something that makes man more than an 
animal, science knows nothing. If man's moral nature be the 
outcome of that portion of his nervous system reflected on the 
viscera it is affected by the manner and object of their exercise 
and it reacts on the viscera from which it springs with a force 
and intensity due to the outer sphere in which it operates. It 
follows that the entire sphere of the spiritual must be recog- 
nized by the physician in his dealings with the mental and 
physical constitution of man as a whole. In other words, the 
whole range of psychology must be embraced in practical 
medicine. 

* * * -X- -* 

There is a great hue and cry made by certain members of the 
profession throughout the entire country of a deterioration of 
race, of a national weakness, a nation of girls, the survival of 
the unfTttest, and that there are causes at work that are sapping 
our vitals as a nation. In several parts of the present work we 
have shown that there can be no real vital deterioration of a 
race, because when that takes place procreation ceases, and we 
have the strongest evidence in making the statement, that the 
modern white lady that to-day walks our streets is a perfect fac- 
simile of MotherEve in size, beauty of form and expression, and 
all are familiar with the fact that a mixture of the colored and 
white race does not produce a hybrid condition, but something 
analogous in the production of a lower race essentially tuber- 
cular which inevitably dies out, so that the mixed race fails to 
be perpetuated. We see also the effects of strong-minded wo- 
men in the production of a race of girls or extremely effemi- 
nate boys with all the rudimentary condition of women. 

The cry of national weakness in the white race is said to 
arise from causes operating within the race, and to be identified 
with civilization and early precocity and affect both sexes 
alike, and is said to originate in self-abuse, sexual excesses, 
leakages and other states incidental to the increasing aclivities 
of the age. It is also maintained, and with great correctness, 
that the vigor, courage, magnanimity of a race bears a direct 
ratio to the strength and power of the generative organs. A 
true index of a nation's position in the scale may be estimated 
by her effeminacy, feebleness, cowardice, imbecility, or by her 
sturdy bellicose attitude. National examples are numerous; 
the ancient Greeks and Romans went to a miserable decay by 
sexual excesses. The decay and decrepitude of the Turkish 
power is solely due to sexual exhaustion. The French in 1870 
exhibited a nation prostrate through sensuality and vice, and 
the sturdy, vigorous German gobbled them up in their might. 
The prowess of the Russians is proverbial, among whom sex- 
ual excesses are rare. 



INTRODUCTION*. 31 

In our late civil war the soldiers of the armies of both North 
and South exhibited daring, courage, physical endurance, 
bravery and noble heroism unequalled in the history of the 
world, which does not exhibit any national weakness. It ma} 7 
be urged that our troops were principally foreigners; that can- 
not be said of our Western, Eastern and Southern forces, who 
were the most reliable, bravest, and exhibited deeds of daring 
equal to the noble Roman, to whom they bear a striking re- 
semblance. The same condition may be traced down to indi- 
viduals, to families. Illegitimate children were usually en- 
dowed with great genius and valor. Both ancient and modern 
history teems with examples. This is attributed to the vigor 
and impetuosity of both parents. Hercules, Romulus, Alex- 
ander the Great, William the Conqueror, Homer, &c, and 
many modern names could be mentioned that were bastards. 
The greatest captains, best wits, most brilliant scholars, bravest 
spirits have been base born; more noble in mind and body 
from the vehemence and force of their parents. 

National and sexual vigor co-exist, the former depending 
upon the latter. But there are causes of national weakness 
produced by seminal losses to be found in masturbation, sensu- 
ality, gonorrhoea, stricture, occupations, fiction-reading, schools, 
isolation of the sexes, solitary confinement, vice and immoral- 
ity, &c, &c. The most prevalent of the causes is masturbation, 
with its sequel, spermatorrhoea or loss of semen. This is an 
evil very difficult to guard against, save, warning and great 
vigilance, for there is no circumstance conceivable in which a 
young person may not fall into it. In the family circle, public 
and private schools, boarding academies, charitable colleges, 
the secret is taught and learned. Even children of very ten- 
der years have been brought to their grave by this inveterate, 
unsuspected habit in both sexes, and it is difficult for parents 
to realize the fact, that they so young can resort to such a prac- 
tice. The ignorant manipulation of nurses often work the ruin 
of children at the breast. 

Self-pollution is that detestable practice by which persons of 
either sex may defile their own bodies in secrecy and endeavor 
to produce for themselves those sensations which nature has 
appended to the communion of the sexes. The practice has 
been coeval with the world's history, and has been the most 
certain and immediate avenue to destruction in both nations 
and individuals — it is simply a lingering mode of death, lin- 
gering and imperceptible but always effective. It is not only 
unnatural, filthy, odious and monstrous, but in its consequences 
ruinous, destroys affections, perverts natural desires and extin- 
guishes all hopes of posterity. 

The causes that give rise to masturbation exist within the 



32 INTRODUCTION. 

body itself, in a kind of precocity of sexual instinct which is 
fanned into existence by stimulating diet, by permitting females 
to sleep with little boys, by the presence of female teachers in the 
public schools, which is a monster cause, together with other 
defects of civilization, dime novels, &c. 

The isolation of the sexes in youth or more mature years is 
a grave mistake ; the sameness of sex, like isolation or solitary 
confinement wipes out the typical characteristics of intelligence 
in the brain, causes a coalescence of the typical fissures, and 
produces a deviation from the normal type which carries its 
victim into sensuality and masturbation. 

This vice invades all ranks ; besides our schools and churches, 
our educational system is a source of intolerable mischief as 
well as the reading matter of the young. 

But suppose the young man escapes this terrible vice and 
contracts gonnorhcea, gleet, stricture, syphilis or other condi- 
tion. The venereal germ is very noxious to the genital organs, 
liable to render them weak besides contaminating the springs 
of life and breaking down the vigor of youth. Very apt to 
give rise to disease of the testicles, prostate, disorders of the 
rectum, and thus engender a leakage. 

In married life there are various conditions, as excess, incom- 
patability, that give rise to leakages in nature. Injuries on 
the head, horseback exercise and other conditions weaken the 
vital integrity of the organs. 

The end of all is in every instance losses, leakages of the nerve 
vital fluid. This may occur in various ways, discharge of semen 
during the night or day; by the urine, or at stool, or by a 
slight oozing or humidity all the time. 

In the loss of seminal fluid, the material of impregnation, 
the human being parts with a portion of life itself, and even 
each act of natural coition, under the most favorable circum- 
stances involves a degree of absolute exhaustion from which 
the system requires time to recover, but how fearfully debili- 
tating it is when there is an oozing all the time. The human 
semin is a vital fluid, loaded with spermatozoa, floating in a 
prostatic secretion, endowed with the property of imparting life 
to a future m an or woman . Th e spermatozoa are numerous, active, 
restless in a healthy man; few, sluggish, non-vitalizing in those 
who have abused their power or been guilty of the practices 
enumerated, The elaboration of the spermatozoa is guided by 
inscrutable power, and forms a stage in the interminable cycle 
of eternity that under favorable conditions develops itself into 
the likeness of omnipotence. 

A continual drain or loss, scanty or excessive leads to pros- 
tration, debility, human weakness, lost manhood, poverty of 
mental power, engenders suicidal mania and crime, and en- 



INTRODUCTION. 33 

feebles the physical constitution and demoralizes the springs of 
action. 

If any city or town can aggregate together a sufficient num- 
ber to constitute a quarter per cent, of males thus affected then 
such a place must be branded as suffering from this so-called 
national weakness. To the uninitiated we will give an average 
description of a victim, one of the hundreds of young men 
that are turned out annually by the great manufactory of the 
solitary vice, Girarcl College. Hideous and frightful is the 
stamp that nature affixes to one of that class. He is like a 
withered rose, a tree withered in its bud, or a wandering corpse. 
All energy, animation and life are killed by this secret cause 
and nothing is left but weakness, inactivity and inertia, wast- 
ing of the body, stunting of the growth and depression of the 
mind. The senses are impaired, the eye loses its lustre and 
brilliancy, they sink in their sockets, he needs glasses ; strength 
vanishes, manliness is extinct ;. honest courage is gone; features 
are sneakish; youth departs, the whole body becomes sickly 
and morbidly sensitive ; very nervous, and muscular power is 
lost; sleep brings no refreshment, no energy, no recuperation; 
the joints are stiff and need lubrication, every movement is 
lethargic ; the feet refuse to carry the body, the hands tremble, 
pains are felt in the limbs. There is usually indigestion, flat- 
ulence, and pains in the stomach are constant. The activity 
of the mind is destroyed only for mean contrivances; wit, 
genius and intellect have sunk below mediocrity, all good tastes, 
lofty ideas are vitiated and his mind is filled with anxiety, de- 
spair, secret reproaches, distressing feelings and cunning crafti- 
ness. The dreadful experience of a living death renders death 
a desirable consummation, for waste of that which gives life pro- 
duces disgust and weariness of life and leads to suicidal mania, 
which is one of the characteristics of this vice. The whole life is 
vitiated, the body shrivelled and wasted and destitute of a soul. 
If he lives he is a pest to his associates, an eating cancer in the 
body politic, a parasite that afflicts man at large. 

Every man in our midst should consult an eminent physi- 
cian as to his bodily integrity and as to the point whether diur- 
nal or nocturnal losses are taking place, so as to wipe out this 
condition, and the vice manufactories should be closed. 

There can be no doubt that this national weakness is some- 
what widespread. We meet with isolated cases of it in almost 
every family; it would seem to be endemic in some towns while 
others were comparatively free from it. Occupations seem to 
predispose to it, the life of a farmer is healthy, but usually 
monotonous, and this latter condition gives rise to it ; hence, 
insanity as the sequel is more common among farmers than 
merchants; the in-door life and solitary existence of women 



34 INTRODUCTION. 

render them also obnoxious to it. Some chemicals act injuri- 
ously, hence photographers are great sufferers from the char- 
acter of the articles they employ. All sedentary occupations 
are bad. It is a condition that should attract all the attention 
of the philanthropist; rouse all the eloquence and force of the 
clergy ; and awaken the inner nature of man to grapple with, 
suppress, and exhibit the tremendous evils arising therefrom. 
Every lover of his species should see to the extermination of 
this great curse. 

We grant the point that there does exist to a limited extent 
a national weakness, but so far it has not changed the American, 
it has not made him more puny and faint-hearted than of yore, 
it has not increased a vitiated progeny, nor so far rendered us 
less able to bear the struggle for existence and against disease. 
Measurements of the crania of ancient Greece and those of our 
Bostonian Athens show that we have bigger heads, more 
prowess and endurance, more real vigor, or grit, live longer 
and resist the ravages of epidemics better than our ancestors. 

Again, if we take the boys, the offspring of literary mothers 
with small heads, or those raised in the institutions mentioned, 
whose brains become dwarfed by isolation, they have small 
mental capacity, and this very state leads them into the de- 
praved habit of self-abuse which in their case arises from an 
undue development of the genital over the volitional and in- 
tellectual propensity or of the ganglionic over the cerebro-spinal 
impetus, then our outlook for the future would be gloomy in- 
deed. It is well for our country's good that women of giant 
intellect rarely marry, or if they do, fail to live in conjugal fe- 
licity and are not blessed with offspring, and the pun} r , sickly 
dwarfs raised in charitable institutions rarely can procreate; 
so we are safe from those two elements of national deteriora- 
tion. 

•x- ■;:- -x- -x- -x- 

All animal and vegetable life begins in a cell or germ. 
Whether the germ is supplied by the spermatozoa of the male 
or ovum of the female, or by a conjunction or union, is not es- 
sential for our purpose. The primordial germ is endowed po- 
tentially with the capacity for forming all the structures of 
varying character of which the fully formed individual consists. 
Blood, skin, bone, hair, teeth, muscles, brain, each in its own 
place and proportion, to the definite extent as to give us a 
mature individual, exactly in size, weight, shape, color, &c, 
following the archetype of its race, but beyond this conformity 
in all its parts, it has impressed upon it and passes on to the 
individual made up of its successive generations to a remark- 
able extent, the physical and structural specialties of its parents. 
It is impossible to see in this germ of different animals any dis- 



INTRODUCTION. 35 

tinction, still less in different human individuals. Yet such 
germ is distinct, through long generations and formations 
of organizations, and is capable of taking on more or less all 
the characteristics of its parents, not only in color of hair, 
eyes, shape, feature, but of temperament and quality of the 
organs into which its progenitor was originally invested, and 
some of the psychical endowments, its height and most exalted 
perfection. From the original germ, we have a proliferation 
of other germs, for every structure or tissue which are held in 
the blood, for in that fluid we have the initial elements or 
germs of all the tissues. These germ elements in the blood 
are called living matter or bioplasm, and are capable of being 
changed, altered, modified or degraded by certain adverse con- 
ditions within and without the individual, and when so de- 
graded it becomes a disease germ. For example a change or a 
degradation of the living matter of ordinary nutrition is al- 
tered into a disease germ, bacteria; a modification or degrada- 
tion of the living matter concerned in the nutrition of the re- 
spiratory mucous membrane gives the diseased germ amoeba ; 
an altering or degradation of the molecules or germs of nutri- 
tion of the nervous s}'stem, become the disease germ vibrios; a 
degradation or rot of all the living elements in the blood gives 
the disease germ oidium albicans; a degradation of the living 
matter concerned in the nutrition of the sexual organs by pro- 
miscuous sexual intercourse, gives us the syphilitic disease 
germ. A degradation of other living matter may give the dis- 
ease germ cancer, tubercle, small pox, &c. 

The germ theory of disease, then, may be briefly expressed in 
a sentence; the modification or degradation of living matter 
in the blood, by adverse conditions of life, into disease germs. 
This is the origin of all contagious or infectious diseases. The 
direct transplanting of disease germs may take place in innu- 
merable ways, being most likely to take hold among those of 
depraved organizations, among persons who live poor, in 
crowded houses where vital forces dwindle, and organic ele- 
ments are feeble ; where hygiene is limited ; insanitary surround- 
ing very bad ; where vital stamina is greatly impaired. 

Although we make the following enumeration of disease 
germs, it must not be accepted as either correct or complete, be- 
cause the subject is merely in an incipient stage of investiga- 
tion and no precise classification can be made. But even this 
imperfect division may assist in the advancement of scientific 
truth, and I leave it with the reader till a more enlightened 
state of knowledge furnishes us with a better. 

The bacteria is the most commonly met with of all disease 
germs, being present in great abundance in all states or degrees 
of mal-assimilation, in boils, erysipelas, wounds, inflammations. 



36 INTRODUCTION. 

Met with in the living fluids under nearly all pathological 
conditions. It is a sausage-shaped germ, sometimes occurring 
singly, but more frequently met with in longer or shorter 
strings like Jersey sausages, often jointed and linked. Amoeba 
are round or spherical bodies very pellucent, usually floating 
free, either singly or in groups or in bead-strings, always wher- 
ever found looking like an 0, best seen in catarrh, bronchitis, 
chronic laryngitis, eustachian deafness, also found in the living 
blood in those diseases. 

Vibrios resemble small feathers or yarrow leaf, strings or 
threads from a stem in constant motion. Found only in the 
blood in nervous diseases as chronic inflammation of brain or 
cord, softening, epilipsy, and is the main factor of typhoid fever, 
in which it is not only in the blood but in the urine, stools, 
sweat sordes, breath. 

The oidium albicans looks like a field of tall prairie flowers; is 
found in the discharge of ozaena, in the ulcers of aphthae, in 
the false membrane or exudation of diphtheria; in gangrene, 
and in the blood in the same diseases, also in spotted fever. 

The above four germs are found abundantly in the blood of 
animals, in a giant form ; as for example the giant bacteria of 
cattle and fowl give rise to anthrax, the giant amoeba to gland- 
ers, &c. 

Besides these there is found the Brownian granules, minute, 
opaque, solid, moving, spherical bodies, which exist normally 
in the buccal mucous cells and white corpuscles and in a dis- 
eased state in blood serum, milk melanotic matter and urine. 

Micrococci are found in small-pox, and putrid fevers in the 
blood. 

Spirilli are merely a species of vibrios, specially present in 
the blood in typhoid ; bacilli are simply giant bacteria, there 
are several varieties, best seen in cattle plague or anthrax. 

There is also the germ tuberculae, cancer, syphilis, yellow and 
malarial fevers, scarlet fever, small pox, rabies, &c. The two 
first, tubercle and cancer have been well defined, but the latter 
are rather imperfectly delineated. 

Germ spawn of all kinds, is a fine granular matter, spoken of 
as clouds of granular debris, which, though infinitesimally 
minute, has nevertheless specific pathological characters and is 
always visible in fluids where mature germs float. Although 
the spawn cannot be isolated, they are entirely indistinguish- 
able from each other, they are nevertheless organically distinct. 

It is not the mere presence of disease germs in the blood that 
gives rise to trouble, but their quantity that gives rise to dis- 
ease. Their presence is always indicative of morbid action 
wherever met, but when in swarms the special disease that 
gives rise to them or they to it is paramount. There are some 



INTRODUCTION. 37 

germs that exercise a local influence, as glanders and rabies, 
before they enter the blood. 

In animals, plants and vegetables wc also meet with special 
disease germs when conditions adverse to vitality prevail, as the 
fruit, protato and vine blight; the epidemic cutaneous dis- 
ease of the silk worm and salmon. It must not be supposed 
that we are acquainted with all the different species of diseased 
germs ; the subject is only in its earliest development, and many 
more remains to be discovered. The point to be clear on is that 
their original formation is due to the living matter of our own 
or other bodies being degraded by some adverse condition into 
a disease germ. That when this takes place it acquires new and 
independent powers of existence, and acquires great, even 
marvelous powers of reproduction, both in and out of the body, 
provided a degree of warmth and moisture be present. That 
they are all contagious and infectious in the true sense of the 
term and their virulence is greatly aggravated if taken from 
an opposite race, or from animals. We see that well exempli- 
fied in the persistent retention of small pox in a most malig- 
nant form in localities where two opposite races live side by 
side. By the fatal effects of the giant bacteria among tanners, 
wool operatives; by the pernicious effects of tubercle from milk 
of diseased cows. 

* * * * * 

The education of women and the engaging of married wo- 
men in intellectual pursuits, thus producing all girls or very 
effeminate boys with small heads is very notorious, but there 
are other causes at work in the production of monstrosities, to 
be found chiefly in a perverted condition of the sense of the 
beautiful in women which illustrates the folly and childishness 
of the race, and is strikingly brought out in the Chinese crush- 
ing the feet of their female children to render them small ; and 
by another race compressing the heads of infants between boards 
to flatten them ; in another by tatooing the skin of the body ; 
others color the skin, but the Caucasian woman possesses the 
most erroneous and perverted of all tastes, the most destructive 
to health, to her own happiness, namely, tight lacing. Wher- 
ever a white woman is found she adopts the practice. 
*■•**#'* 

In no instance has the folly and perversity of women been 
more strikingly displayed than in the various efforts to render 
themselves beautiful. The most absurd and deleterious con- 
trivances are resorted to for the purpose. Our ladies attach 
great importance to a white skin, which they secure by poison- 
ing themselves with bismuth and arsenic; others put great 
faith in hair dyes and nearly all are infatuated with having a 
small waist; they place the greatest importance on this deform- 



38 INTRODUCTION. 

ity, this mischievous shape, the figure of a wasp and with 
great self-denial and extreme suffering laces up her corsets until 
her ribs actually press closely to her spinal column and the 
functions of vital organs in the chest and abdomen are not only 
impaired but organic disease is set up of the most incurable 
kind, and her future life is rendered one of great misery. The 
practice of tight-lacing is a violation of natural laws, and im- 
pedes the proper working of the lungs and heart ; disturbs the 
circulation of blood, prevents its distribution to the brain. Its 
first action upon the lungs. and liver is compression, on the 
former this prevents a proper aeration of the blood ; on the latter 
prevents a decarbonizing or cleansing of the blood. Besides the 
pressing and squeezing of the corsets devitalizes and paralizes 
all the muscles of the back and chest and renders them quite 
hideous in shape in advanced life. 

In proportion as the lungs are impeded, so is the blood im- 
perfectly oxygenized and serated ; this strikes right at the powers 
of life, rendering them feeble and rapidly affects the whole 
body in a general whitling down process, insufficient inflation, 
gives rise to hurried breathing and disease of the heart. 

The liver and gall ducts surfer much from the compression 
as well as displacement, and the victim becomes afflicted with 
various forms of hepatic disease and gall stones. The stomach 
and bowels are not exempt from derangement, so there is indi- 
gestion, constipation. 

But the uterus receives a terrible strain from the superincum- 
bent pressure, which causes it to be displaced in all directions, 
downwards, backwards, forwards and sideways; painful men- 
struation follows. Very often the bowels are pressed down be- 
tween the vagina and bladder or between the vagina and 
rectum or into the femoral ring, and thus rupture of an incur- 
able form is brought about and when the lady marries and 
bears children, outraged nature gives her long and prodigious 
suffering in labor. Her pelvis is deformed and contracted, 
there is always less or more curvature of spine, and she suffers 
a living death. If mothers would only inculcate that in order 
to secure beauty, health must be first obtained. A perfect free- 
dom of all organs, muscles, with their normal exercise, and ac- 
tivity, that there should be no restraint, no pressure to clog or 
impede. 

Deity requires no artificial means to alter or increase the 
beauty and perfection of his work. A Caucasian woman is the 
most perfect piece of divine mechanism, and neither her beauty 
of form nor expression can be increased by tight lacing. No, 
but by the act she compresses her abdominal brain which con- 
trols the blood vessels, which guides the nutrition of the entire 
body. The pressure on the solar plexus gives rise to morbid 



INTRODUCTION, 39 

impressions In the brain proper, and she strangulates the store- 
house of vital force of her body, the fountain of supply. The 
importance of this region so constricted in containing the 
nerves of organic life never can be duly appreciated. 

* v * * * * 

The large proportion of the diseases of the human family are 
of their own production, due to the degradation of the living 
matter of our own and others bodies into contagious disease 
germs ; others are the direct result of a violation of moral and 
divine law, and are capable of prevention. It is not necessary 
to point to the glaring gin palace, the secret brothel, the inter- 
ments of the dead in cities, to sewerage, and other insanitary 
states, neither is it necessary to speak of bad food, deleterious 
trades, insufficient clothing, overcrowding, impure air and no 
bathing, nor to the various defects and vices of civilization as 
manufactories of disease, as they are apparent. Man is beau- 
tifully constructed and protected so as to resist the invasion of 
all outside contagious diseases; none of them can penetrate his 
skin unless it is cracked, and the mechanism of his nose is 
such that they cannot penetrate there, so that when not due to 
causes within the body of the individual there is only one mode 
of access, and that is by the mouth, and if it is kept closed man 
is invulnerable to contagum vivum from without. Nearly 
all contagious disease germs out of the body find their way into 
the blood through the salivary glands of the mouth, such as 
tubercle, cancer, small-pox, scarlatina, &c, etc. ; if man were 
only to keep a close mouth, even if of feeble vital force he could 
live with immunity among malarial, yellow fever, typhoid. 
cholera and other germs. The great secret then aside from a 
high standard of vital force for the prevention of disease is how 
to breathe. Man should breathe exclusively by his nose in order 
to avoid all contagious elisease germs. This is apparent from 
the following anatomical facts: The nasal chambers in man art- 
remarkable for their irregularity of surface and anfractuosity 
and consequently for the enormous area of mucous membrane 
they present within a very limited cubic space. The greatest 
ingenuity has been displayed in the construction of the nasal 
fossa to give this immense surface without increasing bulk or 
weight. In pursuance of this principle all the bones about the 
nose are hollowed out and the chambers so formed that the so- 
called sinuses or channels of those are brought into direct com- 
munication with the nasal passages, and constitute supple- 
mentary air chambers or crypts, and every portion is utilized 
for its proper purpose. The entire surface of this extensive 
tract is covereel with mucous membrane, remarkable for its 
vascularity and high nerve endowment. The upper or olfac- 
tory portion of the nasal surface proper, amounts to about one- 



40 INTRODUCTION. 

half of the whole, and this is provided with an epithelium 
composed of non-ciliated columnar particles interspersed with 
fusiform or olfactory cells, whilst the lower half, which is es- 
sentially respiratory, is furnished with a ciliated columnar epi- 
thelium, same as that which lines the upper surface of the 
bronchial tubes. Over this extensive tract supplemented by the 
accessory sinuses,the eighteen or twenty cubic inches of air 
which constitutes the volume of one inspiration passes and is 
dispersed in thin layers and fine streamlets. The air in this 
act of nasal respiration diffuses itself into the chambers and re- 
cesses and thus becomes heated to the temperature of the body, 
by coming in contact with the vascular lining. The greatest 
portion of the air that enters the lungs in ordinary nasal breath- 
ing is drawn from those chambers and recesses, after it has 
been heated. The inhaled air is supposed to take the sides and 
the expired air to occupy the centre. No doubt to some extent 
they mix and thus become vitiated, for the expired air is loaded 
with carbonic acid gas and is heavier than the lighter and 
static air lodged in the nasal cavities. ^ 

The initial portion of the nasal respiration is devoted to dif- 
fusion through the sinus and chambers, where it is raised in 
temperature, thoroughly cleaned before it is transmitted to the 
lungs, it is thus freed from disease germs, mechanical impuri- 
ties, by a process of sifting which it undergoes by means of the 
cilia of the respiratory portion of the tract, where these extra- 
neous elements become fixed by the abundant viscid mucus 
secreted in those passages. When such impurities are in ex- 
cess as in the case of a miner, cotton operative, knife grinder, 
wool sorter, the natural protection is not sufficient and irrita- 
tion and disease is the result. But under all ordinary circum- 
stances the natural process is sufficient to catch or filter, or sift 
the breathed air from all disease germs. The crusts that form 
in the nose when not due to ulceration are the product of sift- 
ing, filtration and deposition. 

The air inhaled through the nostrils is hygrometrically al- 
tered by coming in contact with moist mucous surface and thus 
becomes charged with a percentage of aqueous vapor inversely 
proportioned to its previous hygrometric condition. This ef- 
fects a most salutary change in softening, mollifying a dry or 
parched atmosphere, such as we often experience in our violent 
wind currents. 

The dry air if breathed into our lungs unchanged would 
cause too rapid evaporation from the lining surfaces of the 
bronchial tubes, lower their temperature inordinately and in- 
terfere with gaseous exchange within the lungs and give rise 
to asthma, bronchitis, and pneumonia. 

The cavity of the mouth of man presents none of these ad- 



INTRODUCTION. 41 

vantages for breathing, indeed, it is not adapted for breathing 
at all. The mouth, the buccal and laryngeal portion of the 
pharynx are covered with stratified squamous epithelium and 
like all surfaces so provided are, by comparison with columnar 
and ciliated surfaces, lowly endowed with vascularity and sen- 
sibility. There are no sub-divisions in the mouth into cham- 
bers, recesses, sinuses. No multiplication of surfaces by pro- 
jections and depressions of surfaces as in the nasal cavities. 
Hence a column of air breathed through the mouth is not 
searched, cleansed, sifted and filtered of foreign bodies, neither 
is it warmed and moistened as if breathed by the nose. The 
saliva will not impart vapor to the air passing through the 
mouth, not to any appreciable extent, neither does air furnish 
a reflex stimulus for the secretion of saliva. This is readily 
preceived in those who habitually sleep with their mouths open 
during the night in the dry, parched state of the mouth in the 
mornings. During the seven or eight hours of sleep with an 
open mouth, no stimulant other than air is applied to the in- 
cident or excitory nerves of salivation, hence the parched state 
of the mouth. The inferences to be deduced then are : that the 
nasal passages are the natural channels for the entrance and 
exit of air, and if judiciously employed, they are as air passages 
adequate for the purpose of respiration and warding off disease. 
They are the natural channels for the introduction of air into 
the lungs and its expulsion therefrom. Their construction and 
organization are such as to keep man free from all contagious 
diseases. The preservation of the nose is of great importance ; 
it should not be injured by snuff, smutty atmospheres and dust. 
The breathing through the nose is the best method of prevent- 
ing asthma, bronchitis, pneumonia and consumption. The 
mouth and fauces are the natural passages for food, if used for 
breathing purposes there is great risk of disease. An open 
mouth is mischievous, it is a receptacle for all noxious germs, 
a closed mouth in breathing is a sure preventive of all diseases 
of the lungs as well as a proper safeguard against all living 
disease germs. Man can face the most deadly living poison 
with a closed mouth. 

To guard against disease germs floating in the atmosphere, 
breathe exclusively by the nose; but it is very difficult to lay 
down rules for the prevention of the ingress of disease germs 
by local contact. It is impossible to say how cancer, syphilis, 
tuberculfe, small pox, typhoid fever, scarlatinia, diphtheria, 
(fee, can be restrained as these human pests can be communi- 
cated. 

By living in close proximity, sleeping on the same bed, using 
the same blankets in a sleeping car, or the sheets or towels of a 
steamship, or hotel. 



42 INTRRODUCTION. 

By wearing bathing suits, ball or funeral dresses hired out. 

By drinking water, but especially milk, from a farm where 
those diseases exist, the use of cups, tumblers, spoons. 

By the water in cars, by the use of water closets, car seats 
and hay. 

By brush, comb, hats, dentists' tools or vaccination. 

By handling ordinary articles as car straps, brooms. 

By toys sold to children on the streets, the seller, probably 
syphilitic, tests the whistle in his mouth and hands it to a child 
who is at once contaminated, as the saliva of diseased persons 
is full of germs. 

By the handling of books, cards, car tickets, canes, gloves, 
pipes, and specially by cigars, the makers of which may be dis- 
eased, and wet the wrappers with their saliva. 

By kissing, in all ages. 

Seeing that there are a. thousand channels through which 
living contagion may reach man, it behooves all to eat the 
best of food, wear woollen clothes, and daily to cleanse off the 
entire body with a bath. To have a variation in diet, in exer- 
cise, in occupation, in amusement, as change is most conducive 
to a high state of mental and physical existence ; as essential 
as pure air is to oxygenate the blood. 

Personal health is as important to the community as to the 
individual. A nation of sick, or of infirm invalids, would 
quickly cease to be a nation at all. All sickness, all infirmity, 
entail a national loss, actual and definite, in consequence of 
which the nation is not only weaker but poorer. AVe do not 
properly appreciate the influence of disease on national pros- 
perity, although we realize it in the individual. If our national 
rulers could only realize the extent to which it is impoverished 
by preventible disease, — rendered poorer by the loss of that 
wealth of which money is the token, they would soon devise 
means to wipe out glaring insanitary conditions and take meas- 
ures to instruct the masses in sanitary science, so that each one 
would have a sound mind in a sound body. 

The greatest possible amount of money spent by our govern- 
ment for efficient sanitary measures, will always prove an actual 
and great economy, and result in a saving of human life and 
an increase of national wealth. 

Nothing is so costly as disease, excepting death ; no waste is 
so extravagant as the waste of human life. 



DIAGNOSIS. 43 



DIAGNOSIS. 



HOW TO RECOGNIZE DISEASE. 

In order to do this with certainty the patient should be ex- 
amined according to a well-defined plan or order. The name, 
age, occupation, residence, temperament, previous history, sex, 
should be carefully noted, and then inspection, palpation, 
measurement, percussion, auscultation, pulse, tongue, skin, se- 
cretions, excretions, heart, respirations, &c, carefully noted. All 
interrogations should be put to the patient in plain language 
such as he can readily comprehend, in systematic order, so as 
to arrive at a precise knowledge as to what kind or nature of 
deviation from health has taken place; and, above all, in our 
examinations and manipulations we should never forget that 
we are learning the disease of a fellow T -creature like ourselves, 
who possesses the same feelings and sensibilities. Prudence, del- 
icacy and kindness should therefore guide our movements. The 
consulting-room of a physician should be as sacred as the con- 
fessional, never degraded into an engine of terror or extortion. 
There should be the strictest honesty of purpose, conduct pure 
and exalted, and everything called by its proper name, never 
overstated, never condescending to anything ignoble, never 
coining names for trifling maladies, or aggravating the type of 
a disease. Patients should not be maltreated by endless ex- 
aminations, speculations, applications, and be drugged for 
years when nothing is the matter. 

Disease is best studied between fifteen and forty-five. Diag- 
nosis during that period is much aided by stability, perfect os- 
sification, pulse, respirations, heart being steady and all the 
functions of the body up to a healthy standard. 

INSPECTION. 

Inspection of the general position of the patient in repose and 
in motion is often very suggestive. The position and attitude 
in fever and inflammation, in paralysis, hydrothorax, asthma, 
colic, and spasmodic diseases are highly characteristic. The re- 
cumbent posture on back indicates debility ; quick forcible 
changes indicate excitement of the nervous system, while fixed 
or restrained movements are dependent on paralysis or inflam- 
mation. 

Inspection of the countenance is of great importance, ob- 
serving Avhether sadness, peevishness, despair, fear, joy, grief, 
or other emotional condition is evinced. The vellow color of 



44 DIAGNOSIS. 

the skin in jaundice, its uriniferous aspect in Bright's disease, 
speak volumes; whereas its conformation tells us much, as the 
corrugation of the brows in pain of the head. Pain in the chest 
causes the nostrils to be drawn upward ; in the abdomen the 
lips to be raised and stretched over the gums and teeth. 

Inspection of the chest refers to the form and configuration 
of the entire thorax and its various parts, and a careful com- 
parison of the two sides, whether in motion or at rest. The 
motions of the chest are referable to inspiration and expiration, 
which pass imperceptibly into each other. In disease these 
motions are altered in various ways. First, by excess or di- 
minution, as in asthma and laryngeal obstruction. Second, by 
partial immobility as in pleurisy, or by augmented expansion 
as in pneumonia and pleurisy. Third, by increased rapidity 
as in pericarditis, or unusual slowness as in coma. 

Inspection of the abdomen is no less important than that of 
the chest. In health it is slightly convex, marked by elevations 
and depressions corresponding to the muscles of its walls, the 
umbilicus, and prominences of the viscera below. It varies 
with age and sex: smooth and flat in the young; broader in- 
feriorly in females than in males, from the greater width of the 
pelvis. In disease it may be enlarged generally and symmet- 
rically, as in dropsies; partially or irregularly in ovarian, he- 
patic, splenic, and other diseases; it may be retracted from ema- 
ciation or intestinal obstruction. The respiratory movements 
of the abdomen bear a certain relation to those of the chest, 
and are increased or arrested with them. In pleurisy the re- 
spiratory movements are mostly abdominal ; in peritonitis al- 
together thoracic. Disturbed relations of the respiratory move- 
ments of both abdomen and thorax are useful points in diagnosis 
in hydrothorax, asthma, ascites, abdominal tumors, &c. 

PALPATION. 

This is a valuable mode of examination, and is best practiced 
by simply pressing the tips of the fingers against the various 
parts. In some cases the whole hand or both hands are used. 
The most favorable position for palpation is the horizontal 
or erect. The information that palpation gives is : First, in- 
creased or diminished sensibility. Second, the altered form 
or shape, size, density, elasticity, &c, of the parts under ex- 
amination. Third, the different kinds of movements to which 
they are subjected. Pain, if inflammatory, is increased on 
pressure ; if neuralgic it is relieved. In paralysis, the diminu- 
tion of sensibility can only be ascertained by feeling the part, 
and the limitation of the anaesthesia is best arrived at by prick- 
ing the surface. Alterations in size, form, density are often 
made out by palpation; a change in elasticity, hypertrophy, 



DIAGNOSIS. 45 

or atrophy is also easily discoverable. Certain motions, as ex- 
pansion, contraction, vibrations, frictions, grating, crepitation, 
are also determined by palpation. The natural fremitus or 
thrill perceptible on placing the hand on the chest when a 
person speaks, is increased or diminished in disease. Fluctua- 
tion is a sensation caused by tapping on or percussing parts in 
such a way as to cause an agitation or wave of their fluid con- 
tents. 

MENSURATION. 

This is another valuable mode of examination, and consists 
in measuring the distance between any two points by a grad- 
uated tape. For measuring either side of the chest or abdo- 
men, a spinous process of the vertebrae should be selected as 
a fixed point, and the middle of the sternum or umbilicus 
for the other. The exact level of the measurement should be 
carefully noted and an allowance of from one and a half to two 
and a half inches made for the right side, or for the left if a 
left-handed individual, and in the case of a blacksmith even a 
little more. The pressure of the corsets in ladies enlarges the 
thoracic but diminishes the abdominal movements. In ascer- 
taining the circular measurement of the chest and abdomen, 
the moment should be selected when the patient holds his 
breath at the time of an ordinary expiration, care being taken 
that the tape is carried evenly round the body. 

Mensuration is valuable in detecting emphysema when the 
ribs bulge out; in hypertrophy of the heart ; when the lungs 
are eaten away in phthisis ; in enlargement of liver, spleen, and 
ovaries. 

PERCUSSION. 

Percussion is best performed by spreading the fingers of the 
left hand not too widely apart transversely across the ribs and 
tapping on them with the right, — the bare hand on the naked 
chest or some very thin intervening body, the patient either 
sitting or in the recumbent posture. The object is to ascertain 
the resistance and size of organs. The sounds elicited by per- 
cussion or beating arise from the vibrations occasioned in the 
solid texture of the organs percussed. The different density 
and elasticity of organs modify the number and continuance 
of the vibrations, and give rise to different sounds. For the 
sake of simplicity all the sounds obtained by percussion may 
be embraced under three heads, and these three sounds are de- 
pendent on the organs containing air, or on their containing 
fluid, or on their being formed out of dense solid tissue. These 
sounds or tones may be termed the resonant, Immoral, and par- 
enchymatous: resonant over organs that contain air, humoral 



46 DIAGNOSIS. 

over organs that contain water, and a dull flat sound over solid 
organs. To become thoroughly familiar with these three 
sounds takes a little time and close attention. The sense of 
resistance is an important consideration in percussion ; it bears 
a relation to the density of the object struck ; thus firm and 
solid organs or textures suffer more resistance than the soft or 
elastic ones. The ribs and entire thorax of a child are very 
elastic ; those of an adult when ossification is complete very 
unyielding. 

Before percussing a person affected with disease, the operator 
should have a clear and accurate knowledge of the limits and 
intensity of clearness or resonance, or of dullness of the entire 
thoracic and abdominal viscera. For example, the lungs from 
top to bottom on both sides are resonant on percussion in health, 
reserving four square inches of dullness on the left side below 
the nipple for the heart and a variation at the base of the right 
lung for an enlarged liver, and of the left for an enlarged 
spleen, of an inch or more from the verge of the ribs. Over a 
healthy lung, then, there is perfect resonance ; but suppose the 
lungs are invaded by tubercle, this diseased germ like all others 
selects the weakest parts for its deposit and growth, which in 
ordinary cases is the apex of the left lung, or the apexes of both 
lungs, depositing itself at the uppermost point and growing 
and being deposited from above downwards. In such a case 
there would be dullness more or less, and the intercostal move- 
ment of the ribs would be arrested. There is one exception to 
the above : if the patient was suffering from irritation of the 
liver, the branches of the eighth-pair of nerves that cover the 
upper lobe of the right lung might be so weakened as to per- 
mit passive congestion, and dullness on percussion would be 
found. This only happens when the integrity of that nerve is 
weakened and all the blood-vessels it supplies thereby relaxed. 
There is scarcely any stage of deposit of tubercle in the apexes 
of the lung that fails to be detected by percussion; whereas 
when inflammation takes place it almost invariably begins in 
the large aerating surface of the lower lobe of the right, which 
is abundantly supplied with the sympathetic nerve, and it may 
proceed up the same lung or pass over to the left. Perhaps the 
only exception to the rule of dullness at the base would be in 
the closing stage of melituria or diabetes, when tubercle is 
thrown out at the base. As a general rule, then, congestive con- 
solidation, the result of inflammation, begins at base. In some 
cases of tuberculosis, right in the centre of a lobe weakened by 
some irritation there may be an encysted mass of tubercle as 
large or even larger than the closed fist, and both apex and 
base clear on percussion. This mass may remain, or it may 
die and be expectorated, leaving a chasm or cavity or cavern 



DIAGNOSIS. 47 

in the lung, in which an undue resonance can be detected and 
mapped out. An undue resonance or a tympanitic sound may 
then be due to a cavity left vacant by expectorated tubercle, or 
it may be due to a dilatation of the air-cells into pouches, or to 
infiltration of air at the abrupt angles or corners of the lung 
which is present in emphysema. A lobe or an entire lung- 
may ulcerate away in consumption, giving rise to this sound on 
percussion, in which case there would naturally be a collapse 
of the ribs, whereas in emphysema there would be more of a 
bulging. 

Water may be effused into the cavity of the chest, the result 
of pleurisy, an obstruction about the heart, and can be readily 
ascertained by first percussing the chest of the patient when 
lying down, in which position the water, if there is any, in the 
cavity of the chest will gravitate to the back and the lungs will 
float, when the chest will be found clear from top to bottom; 
then sitting up, the dullness, if there is water, can be detected 
and its height marked. 

The diagnosis of affections of the heart constitutes the most 
difficult in the art of medicine. Any increase or diminution 
in size can be readily appreciated and detected. Its size varies 
with the individual ; four square inches or the size of the closed 
fist is reckoned normal, but in effusions from the perioardium 
which are so common in chronic rheumatism, the area of dull- 
ness is increased to a greater or less extent. 

In hypertrophy there is often a vast increase, so much so that 
dullness is great ; there is a bulging to a considerable extent, 
In percussing the solid organs like the liver, great care is neces- 
sary to carefully map out its boundaries ; the superior margin 
is generally found from one to two inches above the margin 
of the ribs, while its inferior boundaries extend to a consider- 
able distance. Variations in the size of the liver are great in 
our climate, extending from simple congestion, inflammation, 
induration, enlargement, abscess, hydatids, tumors, down to 
wasting or atrophy, and all can often be detected by percussion. 
In aggravated jaundice, as a symptom of organic disease of the 
liver, the increase or diminution in size of the organ will bear 
a proportion to the disease. If the gall-bladder is distended 
by bile or gall-stones, it is easily detected by percussion, and the 
dullness under the inferior margin of the liver, anteriorly and 
somewhat laterally, may be marked out, The size of the spleen 
is four inches long and three inches wide. In diseased states it is 
either enlarged or atrophied. In percussing this organ the pat- 
ient should be on the right side. The sounds elicited on percus- 
sion of the stomach, bowels, bladder, are of great value in deter- 
mining the size and position of other organs, as liver and spleen, 
also in locating tumors, and effusion of fluids. In dropsy of the 



48 DIAGNOSIS. 

abdomen the swelling is equitable. On percussing the abdomen 
with fingers of the right hand with the fingers spread of the 
left, their points resting on the opposite side of the abdomen, 
patient standing, a wave, undulation or fluctuation, can be de- 
tected very easily, and if not satisfactory empty the bowels 
with oil, and put the patient in a recumbent posture ; bowels 
being empty will float on the top of the water, as the water has 
gravitated to the back; then the standing posture should be 
again tried. A correct appreciation of the state of the bladder 
is also obtained by percussion. In percussing the kidneys turn 
patient over flat on the abdomen, so as to get a clear appreci- 
ation of the renal organs. 

AUSCULTATION. 

This consists in applying the ear directly through a stetho- 
scope to the chest, abdomen, or other parts of the body, to listen 
to sounds or murmurs. Its object is to ascertain and appre- 
ciate sounds and their nature, and its utility is limited to 
the pulmonary and circulatory organs. Before resorting to 
this method of diagnosis, it is well to refresh the memory with 
what exists in health. If we place the ear over the larynx and 
trachea of a healthy adult male, we hear two sounds or noises, 
one accompanying inspiration, the other expiration: they are 
called the laryngeal and tracheal sounds or murmurs. Move 
the ear to the right or left of the sternum, and you will hear 
the same sounds, only diminished in intensity; these are now 
called the bronchial sounds or murmurs. Place the ear under 
the nipple of the right side and two fine murmurs will be de- 
tected, normal vesicular respiratory murmurs. Keep the ear 
at the same place and cause the patient to count one, two, three, 
and so on, and there will be a peculiar impetus or sound of the 
voice called pectoriloquy or bronchophony. 

With regard to these healthy sounds, it must be borne in 
mind that vocal resonance originates in the larynx and dimin- 
ishes or increases from the point or source of the sound, modi- 
fied by the textures in transmitting it. In all morbid states of 
the lungs these natural sounds are altered and new or abnor- 
mal sounds are developed. The alterations of the natural 
sounds in diseased conditions may consist in their being in- 
creased, diminished, absent, or location changed ; the most com- 
mon change is in intensit} 7 , often stronger or weaker, indicating 
increased or diminished action. They may be altered in char- 
acter, the sounds becoming harsh as in pneumonia, cavern- 
ous when a cavern exists in the lung in consumption, am- 
phoric in pneumothorax. There may be also an alteration in 
position ; that is, sounds which are natural to certain parts of 
the chest are heard distinctly at other places whereas in health 



DIAGNOSIS. 49 

they were never detected. For instance, in pneumonia, bron- 
chial or tubular breathing may be evident when only a vesicu- 
lar murmur ought to exist. 

The inspiration in health is three times as long as the expi- 
ration, but in certain diseased conditions this relation is altered 
or inverted. For all practical purposes all the abnormal sounds 
may be classed under three heads : First, rubbing or friction 
sounds. Second, moist rattles. Third, vibrating murmurs. 

Besides these there may be whistling, blowing, cooing, rasp- 
ing and other rales or rattles caused by different impediments, 
mechanical obstruction. 

1. Rubbing or Friction Sound. — This is caused by an irri- 
tation, inflammation, an effusion of serum in serous membranes 
which elevates the membrane into little blebs or blisters the 
size of a pin-point or head of a pin. It is a condition that we 
find after death in irritation of the membranes of the brain, 
peritoneum, pericardium, and pleura. In acute pleurisy about 
four or five clays from rigor it can be very distinctly heard imme- 
diately over the site or location of the stitch or catch. On putting 
the ear to the place, we hear a rubbing like two pieces of brown 
paper being rubbed against each other. In health the pleura 
of the lungs and the pleura of the ribs are smooth, silky, finely 
lubricated ; but when a partial death takes place, this effusion 
occurs with other symptoms of inflammation : they become 
dry. rasping, grating, and we may hear any degree of friction 
noise. The sound may be altered in various ways ; the stage of 
inflammation modifies it greatly. Although most distinct in 
pleurisy, we also hear it very finely in all forms of pericar- 
ditis. 

2. Moist Rattles. — When serum, or mucus, or muco-pur- 
ulent matter, or liquor sanguinis, or blood are effused into the 
bronchi, the air in the act of inspiration and expiration is 
forced down and then up through them, which causes a bubbling 
or rattling or crepitating which can be distinctly heard by the 
ear and often felt by the hand. A large number of names are 
applied to this, but in all cases there must be a fluid to the 
moist rattle, so fine in some cases as to be scarcely audible 
(crepitating) ; so coarse as to resemble a gurgling or splashing 
(cavernous) ; and between these two grades medical experts 
enumerate a large number of rales or rattles, as mucous, sub- 
mucous, sub-crepitating. For all practical purposes, just ad- 
here to the term moist rattles. These are present in bronchitis, 
pneumonia, phthisis. 

3. Dry, Vibrating Murmur. — The wheezing or vibrating 
murmur is chiefly brought about by an irritation of the nerves 
that supply the circular muscular fibres of the bronchi, causing 
a contraction. *\Ve have excellent examples in asthma, whoop- 



50 DIAGNOSIS, 

ing cough, and emphysema, and in some cardiac diseases. There 
is a true condition of spasm, obstruction, loss of tone and elas- 
ticity in the bronchi, whereby the vibrations into which they 
are thrown by the column of air produce tones of an abnor- 
mal character. The murmur is usually dry, and the fineness 
or coarseness of the sound will depend on the calibre of the 
tube or tubes or cavity thrown into vibration. Murmurs may 
exist from a fine squeaking to a hoarse snoring. 

THE HEART IN HEALTH AND DISEASE. 

In placing the ear to the heart, we should pay attention to 
the impulse, to the character and rhythm of the sounds, to the 
place they are heard loudest, and the direction in which they 
are propagated. 

First find the spot where the apex of the heart beats or strikes 
against the walls of the chest, then listen to the sounds ; then 
place the ear two and one-half inches above, a little inward, and 
listen to the sounds there; in the first position, where the apex 
strikes the chest we have the systolic sound, and two and one- 
half inches above the diastolic sound. 

There are two sounds, then, heard over the region of the 
heart. The first is dull, deep, more prolonged than the second, 
coincides with the shock of the apex of the heart against the 
thorax and immediately precedes the radial pulse ; it has its 
maximum intensity over the apex of the heart below and in- 
side of left nipple. The second sound is sharper, shorter, more 
superficial, has its maximum of intensity two and one-half inches 
above the other, and there is a gurgle in it. These sounds have 
received the names, systolic (contraction), and diastolic (dilata- 
tion), the former when the apex strikes the ribs in contracting, 
the other in opening to receive the blood. The two sounds are 
repeated in couples. First, there is the long dull sound, coin- 
ciding with the contraction of the heart. Second, there is a 
pause. Third, the short, sharp sound. Fourth, a longer pause ; 
all of which correspond to one pulsation. 

With the systolic (contraction) sound we have the striking of 
the apex against the chest- walls, then contraction of the ven- 
tricles, then rushing of the blood through the aortic orifices, 
followed by flapping of the auriculo-ventricular valves. 

With the diastolic (dilating) sound, we have the rushing of 
the blood through the auriculo-ventricular valves and flapping 
together of the aortic valves. 

In disease, there may be a modification of the sounds heard 
in health, or there may be new and abnormal sounds devel- 
oped. The modifications of healthy sounds are variations in 
their seat, intensity, extent, character, and rhythm. 

For example, the sounds may be heard at their maximum 



DIAGNOSIS. 51 

intensity lower than the natural point in cases of dilated hyper- 
trophy of the left ventricle, enlargement of the auricles, or tu- 
mors at the base depressing the organ. ■ They may be higher, 
owing to some abnormal swelling, or more on one side than 
another by effusions of air or fluid into the pleural cavity, or 
tumors, aneurisms, deformity. 

The intensity and extent of the sounds may be diminished 
in atrophy, in fatty heart, nervous insufficiency — when there 
is a pericardial effusion, concentric atrophy of left ventricle, or 
emphysema. The intensity and extent of the sounds are in- 
creased in cases of dilated hypertrophy, nervous palpitation, 
or when the adjacent parts of the lung are indurated by effu- 
sion in inflammation or tubercular deposit in phthisis. The 
character of the sounds may be clearer or duller than in health, 
according as the walls of the heart are thinner or thicker. The 
sounds are muffled in cases where effusion has taken place into 
the pericardium. Sometimes they are rough when due to in- 
flammatory changes. 

The frequency of pulsations varies in different affections. In 
certain diseased conditions the beats may be intermittent, or 
there may be pauses, or they may be irregular. There may be a 
variation in sound, an insufficiency of action, in other cases it 
may be irregular. There may be a variation in sound : a want 
of harmony in the occurrence of the two sounds, one faint the 
other tumultuous. 

All the diseased sounds of the heart may be classed under 
two heads. First, friction murmurs. Second, blowing or vibra- 
ting murmurs. The friction-sounds are clue to inflammation. 
The vibrating murmurs depend on some organic change, gen- 
erally the result of inflammation. These murmurs vary in 
character from a general blowing or puff as if from the nozzle of 
a bellows (bellows murmur), whilst others are harsher, grating, 
or sawing, but all caused by diseased condition of the valves. 
Sometimes the valves do not close, and as a result the blood 
regurgitates through them; in some cases the valves are con- 
stricted, shriveled, indurated, roughened, calcareous. The 
diseased sounds may be single or double, and have their origin 
either in the auriculo-ventricular or arterial valves, or in both. 
These sounds often resemble musical notes ; more or less re- 
sembling the cooing of a dove, singing, whistling; all depend- 
ing upon some excessive narrowing of the orifices, perforation 
of the valves, irregularities in their margins, or exudations or 
deposits on their surface. 

Not infrequently a soft systolic blowing is audible at the base 
of the heart, or over the carotids and deep jugular vein ; some- 
times it is continuous, resembling the humming of a top. These 
murmurs, which are so common in poor blood, are easily dis- 



OZ DIAGNOSIS. 

tinguished from valvular ones by being systolic, by their soft- 
ness, and by their presence when the substance of the heart is 
imperfectly nourished. On listening over the arteries in the 
vicinity of the heart, the same sounds can be detected. 

In peritonitis, the friction-sound is often heard, and some- 
times a grating. Various sounds are heard in the bowels, &c. 

Auscultation, percussion, and other means of diagnosis are 
not to be depended on alone; they are simply aids, modes, or 
means of reaching an end, and should be strengthened by ob- 
servation of the pulse, tongue, skin, heat, temperament, urine, 
and other means of a definite character. 

THE PULSE. 

The pulse at birth averages 130 per minute. There is a 
gradual decline till puberty, when it reaches its permanent 
standard, from 75 to 80. From fifty-five years of age upwards 
there is a gradual decline, so that in old age it ranges about 60. 
In persons of a sanguine temperament it is about five or six 
faster than the bilious. In females it averages ten beats more 
than in males. The recumbent posture causes a lowering of 
the pulse of about eight or more beats per minute. The pulse 
being the sign of this or that disease, is also the sign of non- 
existence of special activities, of strength and weakness, of irri- 
tation and relaxation of certain tissues. The more frequent the 
pulse, the greater the heat; the more rapid the respiration, the 
weaker the patient, 

Frequency is the characteristic of all fevers and inflamma- 
tions. 

In acute rheumatism, frequent but remarkably full. 

In all acute inflammatory diseases, firm. 

In all abdominal inflammations, small, wiry, and frequent. 

In fevers proper, large and soft, or small and feeble, but fre- 
quent. 

In aortic regurgitation, hammering. 

In hemorrhage, jerking. 

In old age and in all conditions of arterial degeneration, hard 
and incompressible. 

In excitement, rapidity and shortness of stroke. 

In all acute inflammations of the brain, remarkable for its 
great frequency. 

In cerebral disease, very unequal and depressed. 

If there is pressure on the brain, slow and labored. 

In disease of the heart, irregular. 

In aortic regurgitation, although hammering, it is remark- 
ably faint and feeble. 

In syncope and cholera, imperceptible. 

In all conditions of prostration, more or less faint. 



DIAGNOSIS. 53 

When disease affects origin of subclavian, pulse only found 
on one side. 

In all conditions of depressed vital force, frequent, unless 
there exists some mechanical impediment like emphysema. 

Pauses in the pulse, or an intermittent, pulse, depend either 
upon disease of the brain or heart. 

Pauses in the pulse, still not quite intermitting are often pres- 
ent in the users of tobacco, the nicotine affecting base of the 
brain. 

THE TONGUE. 

The tongue is an excellent index of the state of the stomach 
and bowels ; it often indicates the state of blood and brain. 

A heavy white coat, with or without elevated papillae, gas- 
tric derangement. 

A brown coat in centre and white at sides, derangement of 
stomach and liver. 

A very dark brown, gingerbread, or even a liquorice aspect, 
malignant bilious fever, or typhus. 

A charcoal hue at root indicates blood-poisoning. 

A fur on tongue, catarrh of the stomach. 

Transverse fissures on the tongue, intestinal irritation. 

Longitudinal tracks, irritation of the kidneys. 

Sharp-pointed tongue, nervous irritation. 

A large flabby tongue, glandular disease. 

A smooth raw-beef tongue, acute inflammation of the 
stomach. 

Red tip and edges, sharp-pointed, with white coat, or fur or 
other coat in centre, chronic inflammation of the stomach. 

A large, flabby, tremulous, creamy tongue, delirium tremens. 

Tremulous, and patient thrusts or darts it out, in chorea. 

Buff coat, like new leather, very dry, sharp-pointed, or it may 
be patchy, or papillae elevated, typhoid fever. 

Peculiar buff leather appearance in enteritis. 

Thick coating, white or brown, mal-assimilation. Aphthae, 
or ulceration in patches, mal-nutrition very great, so as to 
cause degradation of healthy living matter into micro-organ- 
isms ; if very patchy the irritation may be deep. 

Strawberry tongue, perhaps surface slightly coated in streaks, 
papilla? projecting greatly, is characteristic of scarlatina. 

In hysteria, tongue often morbidly red, moist, with or without 
a coat. 

The tongue is shining, glazed, or chapped in ulceration of 
the bowels. Warts on edges near root indicative of syphilis. 

Tongue drawn to one side, effusion upon base of the brain of 
the opposite side. Red like a piece of raw beef, with a dark 
hue at the root, gastro-peritonitis. 



54 DIAGNOSIS. 

THE SKIN. 

Heat and cold alternately in the entire skin or a part of it 
indicates nervous depression. 

Peculiarly thin and easily raised from the subcutaneous tissue 
in consumption and wasting diseases. 

A feeling of fullness and tension in the eruptive fevers, 
amounting to even a sense of hardness in erysipelas, and a 
gritty feel in smallpox. 

The nails are clubbed, and hair falls off, in tubercular dis- 
ease. Loss of hair is common in the convalescing from fevers 
and in syphilis. 

The skin is dry, harsh, in children suffering from tubercular 
disease. 

Remarkably moist, soft, doughy in delirium tremens. 

Perspiration is sour in rheumatism, also in diseases attend- 
ant on mal-assimilation ; an excessive perspiration of any kind 
may be accompanied with small blisters on the skin, sudamina. 

Profuse drenching or colliquative sweats indicate great de- 
bility or exhaustion, as in lung-consumption or profuse suppu- 
tion. 

A rigor or chill indicates nervous depression, and either fore- 
shadows a fever or formation of an abscess. 

Rigor, with the cutis anserina or plucked-goose skin, denotes 
the presence of the malarial micro-organisms irritating the mi- 
croscopical nerves of the skin, causing the muscles to contract 
in two different directions, thus creating a puckering. 

Rigor occurring during the progress of inflammation indi- 
cates the formation of pus. 

The crackling feel of emphysema is very characteristic, as is 
also the doughy character and pitting under pressure of anasarca. 

Protuberant eyeballs, wasting disease. 

THE APPETITE. 

Becomes excessive in diabetes. 

Craving in mesenteric disease. When intestinal worms are 
present, variable and capricious. 

In hysteria or anaemia of spinal cord, morbid, craving chalk 
or other alkaline substances. 

In pregnancy, very fanciful, longing for articles of food usu- 
ally abnormal. 

In dyspepsia, variously altered. 

THIRST. 

A central origin in the brain or medulla must be assigned 
to thirst analogous to the sensation of want of breath, or air 
hunger. The sensation is peripheral, due to the excitation of 
nerves in mouth and throat, which pass from the centre. 



DIAGNOSIS. 00 

In diabetes it is remarkably increased. 

In cholera very urgent, 

In diarrhoea, urgent but less so than in cholera. 

Diuresis with uncommon thirst, when there is no sugar in 
the urine, generally due to anaemia of cord or hysteria ; not at- 
tended with hunger, urine of very low specific gravity. 

Generally increased in all fevers. 

ALTERATIONS OF COLOR. 

In anaemia the skin is remarkable for its paleness ; in chlor- 
osis for its greenness. 

In dropsy, from albuminuria, the skin is not only pale but 
white. 

In nervous irritation, often of a marbly whiteness. 

In phlegmasia dolens, where there is inflammation of veins 
and coagulation of their contents, the skin is as white as 
snow. 

There is a dingy yellow hue in, cancer which is easily distin- 
guished by the pearly lustre of the eyes. 

The yellowness of jaundice varies from a pale to a deep green 
yellow and saffron color. 

Redness of the skin, when local, indicates congestion ; when 
general it maybe due to erythema, measles, scarlatina, heat, or 
erysipelas. Redness in gout or rheumatism is usually local. 

In diseases of the spleen and lymphatics, whiteness and 
pallor; but when the blood is not greatly affected, it may be of a 
muddy hue. 

In cholera morbus and malignant cholera, blue ; in non- 
aeration of blood, in pneumonia, bronchitis, disease of heart, 
cyanosis, blue, especially the lips, neck, ears, nails, face, &c. 
Lividity might be applied to it instead of blueness, but this 
term is applied to incipient gangrene. 

Spots, patches of discoloration, valuable in the recognition of 
certain fevers, purpura, scurvy, lead-poisoning, syphilis, and 
cutaneous disease. 

In disease of the supra-renal capsules, bronzed. 

In a well-marked case of malarial fever blueness may be 
looked for. 

The skin is of a peculiar uriniferous color and odor in 
uraemia. 

Purple spots or patches in purpura and scurvy. 

The pallor of anaemia and the greenish waxy hue of chlorosis 
are never to be confounded with the pasty hue of kidney-disease. 
The puffy appearance about the e} T elids with anaemia is an in- 
dication of albuminuria, 

The sallow hue of malignant disease is but another form of 
anaemia. 



56 DIAGNOSIS. 

In disease of the heart and chronic bronchitis, the blue, livid, 
or slate color of the nose and lips is remarkable, and contrasts 
strikingly with the dusky hue of pneumonia or the hectic 
flush of phthisis. 

In measels and typhus fever, suffused eyes are exceedingly 
characteristic. 

Irregular habits of living generally indicated by a bloated, 
blotched face. 

In erysipelas, mumps, facial paralysis, the face undergoes re- 
markable changes. « 

SENSATIONS. 

Flashes of heat and coldness are peculiar to nervous derange- 
ment. 

An aura epiliptica consists in a sensation of some kind, it 
may be like a gust of air on the side of neck and head, or a creep- 
ing up the arm or leg, or cold water running down the back, 
a feeling of insects in the skin, etc. 

A sensation of pins and needles, or a pricking sensation, is 
peculiar to paralysis. 

There is a great contrast between the external coldness of the 
body and the sensation of internal heat by which the patient 
is oppressed. In diarrhoea there is often chilliness. 

The heat of fever is often remarkable. 

The sensations of a hypochondriac or hysterical patient are 
often opposed to the evidence of the senses and good reason. 

A patient's complaint of want of sleep is sure to be exagger- 
ated. The attendant's statement alone should be relied on. 

The sympathetic or reflex pains are important. Pain in the 
right shoulder is indicative of disease of the liver. Pain in the 
sacrum, of inflammation of the uterus. In the knee, of inflam- 
mation of the hip-joint ; of the meatus, of stone in the bladder. 
At the orifice of the urethra, with aching in the thigh and re- 
traction of testicle or irritation of the ovary, irritation of the 
kidney. In the cerebellum, of exhaustion of the lumbar portion 
of the spinal cord A feeling as if scalp was rising, indicates 
irritation of the pneumogastric nerve. Drowsy, sleepy sensa- 
tion, or coma may be due to bile or urea in the blood. 

Pain anterior and posterior over either chest or abdomen 
denotes carcinoma. 

Pain in the crown of the head, chronic inflammation of the 
womb. 

EMACIATION SEEMS TO AFFECT, 

In phthisis, the arms and thorax most, face least. 
In abdominal disease, the lower limbs and face. 
In disease of pancreas there is remarkable emaciation. 



DIAGNOSIS. 57 

Increase of bulk often becomes remarkable in dropsy, say of 
the abdomen, of a limb, or of the head. It may arise from an 
internal or external tumor. 

A delicate appearance, with long fringed eyelashes, points 
out the tubercular diathesis. 

The thickened alas of the nose and upper lips of tubercular 
disease are most marked in childhood. 

POSTURE AND GAIT. 

Inability to stand depends on weakness, vertigo, paralysis. 
In weakness and vertigo the patient reclines, in paralysis he sits 

In curvature of the spine and disease of the hip the body is. 
bent to one side. 

In excitement the gait is quick. 

In debility, slow. 

In disease of the brain and paralysis, labored, staggering, 
uneven. 

In rheumatism and disease of joints, stiff, halting. 

In chorea, constant involuntary moving. 

In nervousness, tremor, and more especially in delirium 
tremens, regular shaking like shaking palsy. 

Tonic spasm occurs in tetanus, disease of the spinal cord, 
poisoning with strychnine. 

Catalepsy is a peculiar form of tonic spasm; cramp is its 
mildest manifestation. 

Clonic spasm occurs in epilepsy, eclampsia, chorea, and hys- 
teria ; subsultus is also a form of clonic spasm allied to tremor. 

In mania and delirium tremens, the muscular movements 
are exalted. 

The muscular movements are generally diminished in idiocy 
and imbecility and in paralysis. A certain restlessness belongs 
to hypochondriacs and more rarely to hysteria, allying them 
with delirium in the external manifestation. 

POSITION. 

Head chiefly elevated in disease connected with the heart, 
less frequently in disease connected with the lungs. 

Head bent forward when there is pressure on the trachea. 

Patient may be unable to lie down from pain of head or gid- 
diness. 

Lying on the back is the position of debility ; also position 
for paralysis when combined with inability to alter it ; also in 
acute rheumatism. Same position assumed in acute gastritis, 
peritonitis, metritis, cystitis, with head and shoulders elevated 
and knees drawn up toward the abdomen. 

A prone position is generally assumed in abdominal spasm or 
colic. 



58 DIAGNOSIS. 

A doubled-up position, with or without vomiting, is present 
in colic, the passage of a gall-stone or a calculi through the 
ureter. 

EXPRESSION. 

In disease of the heart, and in urgent dyspnoea, acute laryn- 
gitis, the face is remarkably anxious and contracted. 

When there is much pain in a vital organ, the face is pinched 
and contracted. 

Immobility most remarkable in catalepsy, or in states of 
unconsciousness and under the influence of spasm and in 
tetanus. 

In nervous disease and hysteria, the opposite state exists. 

By the swelling of erysipelas the face is materially altered, 

CHARACTER OF THE STOOLS. 

Digestion during the clay in stomach. During the eight hours 
of sleep it is carried on in the bowels, and the peristaltic wave 
is started in the act of masticating breakfast. The entire ingesta 
is emptied into rectum, so one defecation in the twenty-four 
hours. Any deviation from the rule is disease : more frequent 
diarrhoea, less frequent constipation. 

Watery, mucous, in diarrhoea. 

Undigested food in stools shows that stomach, liver, pancreas 
are at fault; if fat is passed, the latter. 

Very solid and retained longer than twenty-four hours, con- 
stipation. 

In typhoid fever, like pea soup. 

In cholera, like rice-water. 

In acute dysentery, blood, mucus, pus. 

In chronic dysentery, muco-purulent discharge. 

When an internal abscess bursts into intestinal canal, pure 
pus. 

When black, the stools are likely to contain blood. 

In piles or hemorrhage low down in bowel, blood of a natural 
color. 

In deficiency of bile they are clay-colored; in excess very 
dark brown. 

When fermentation supplants digestion, frothy, yeasty. 

Enlargement of prostrte causes the stools to become flattened 
like a ribbon. 

In stricture of the rectum, cut or chopped into flattened pieces. 

In disease of the pancreas, there is fat or oil-globules in the 
stools. 

Green, resembling chopped spinach in color, irritation of brain. 

In intestinal catarrh, stools mixed with mucus. 

Scybala imbedded in mucus, an affection of the colon. 



. DIAGNOSIS. 59 

RESPIRATION. 

The normal pulse divided by four gives the number of res- 
pirations per minute, provided there is ho disease of the brain, 
lungs, or heart. Number of respirations at various ages per min- 
ute : First year, 35 ; second year, 25 ; at puberty, 20 ; adult age, 
18; old age, 15 to 16. Most frequent in inflammations and 
fevers. 

Pauses in respiration, cerebral or cardiac disease. 

Stertorous, labored, with deep sleep, in inflammation of brain, 
apoplexy, congestive fevers, as typhus. 

Imperceptible in collapse, cholera. Very embarrassed in 
cardiac and bronchial disease. 

Hurried or excited respirations are common in nervous ex- 
citement, hysteria. 

The odor of the breath is often significant. It has a chloro- 
form odor in melituria, diabetes, and chronic alcoholism, when 
there is sugar in the blood. 

Loud respiration under all conditions in which the air-cells 
are less permeable. 

Feeble respiration may be produced by pleuritic effusion, adhe- 
sion of the lungs to chest-walls or obstruction of air-passages. 

Absence of respiration in catalepsy or great weakness. The 
respiration is often prolonged in emphysema. 

The respiration is often grating, caused by thickening of the 
air-cells; grating and short in acute bronchitis and pulmonary 
congestion. 

It is often tubular or blowing, which indicates induration or 
pulmonary condensation. 

It is often cavernous or hollow upon the breaking* up of cav- 
ities in the lung. 

It is sometimes buzzing, which indicates a large cavity in the 
substance of the lung. 

The rhonchus and sibilant rales are dry, sonorous, whistling, 
cooing, snoring, in inflammation of the bronchi. 

The crepitating rale resembles the friction of the hair rubbed 
between the fingers ; it is to be heard when resolution begins 
in pneumonia or bronchitis at the seat of congestion. 

The sub-crepitating is the ordinary moist rattle caused by 
air going down and up through a fluid — the density of the 
fluid modifying the sound. 

TEMPERATURE. 

The pulse at birth ranges from 130 to 140 ; respirations from 33 
to 40, and animal heat from 102° to 103° Fah., from which period 
to puberty there is a gradual decline. From puberty to twenty- 
five, the pulse reaches 70 or 80; respirations, IS, and the tem- 
perature 98°, Fah., at which they remain if in perfect health 



60 DIAGNOSIS. 

till between forty-five and fifty-five, when there is an appreci- 
able decline. A rise is indicative of diminished vitality and dis- 
ease, and the greater the rise the more aggravated the loss of 
vitality; and a continued depression, if persistent, is indicative 
of disease. Observations by the thermometer should be made 
morning and evening, and a due allowance made for the di- 
minished electrical condition existing in the night, during 
which time the type of all diseases is much intensified, and labor, 
death, and other conditions are more likely to occur. In apply- 
ing the thermometer the bulb should be placed under the tongue, 
mouth closed, or applied in the arm-pit, or to the groin or belly, 
and be retained in close contact with the skin and well covered 
and allowed to remain several minutes. 

In all conditions of partial death, as in fever and inflammation, 
we have an elevation, whereas in collapse, emphysema, cholera, 
atrophy of heart, &c, there is a remarkable decline. A rise to 
103° to 105° is indicative of danger; above that almost invari- 
ably fatal. A lowering, if persistent, below 85°, unfavorable ; 
a very sudden fall below that occurring in an acute attack of 
peritonitis, &o, may indicate gangrene, or perforation of bowel 
in typhoid. During convalescence, a sudden rise in tempera- 
ture, pulse, and respirations may indicate a relapse. 

We have no instrument superior to the index and adjoining 
fingers for the pulse, and by the hand laid flat across the base 
of the chest the respirations can be easily counted. 

If there is no disease of the brain proper, heart or lungs, 
there will be a perfect harmony existing between heat, pulse, 
and respirations. Pulse 72, divided by four, gives respirations 
18 and heat 98° in health, with the rise or fall of each in disease. 

SMELL. 

The diagnosis by smell is of great importance. Most physi- 
cians are able to name the disease from the odor of the sick- 
room, because special diseases have diagnostic odors, although 
cleanliness, ventilation, and sanitary measures have done away 
with the smells that formerly assailed the nostrils of the physi- 
cian. 

Measles, scarlet fever, and smallpox are easily recognized by 
their odor. The patient will often recognize the dreadful smell 
of smallpox, and compare the odor of his skin to that which he 
first experienced on taking the disease. 

The odors of typhoid fever and pneumonia are perceptible 
near the patient and in the room. 

There is also a peculiar emanation in tuberculosis, in cancer, 
and syphilis, diagnostic of each. 

The odor of hydro-sulphate of ammonia is always present in 
open cancer, and on that smell we place great reliance. 



DIAGNOSIS. 



61 



The mousey smell of erysipelas, carbuncle, and typhus fever 
is indescribable. 

There are various odors in the lying-in chamber emanating 
from the patient, — the usual odor of the lochia, that of the lacteal 
secretion, and that which indicates the approach of puerperal 
fever. 

Many women emit a peculiar odor while menstruating, which 
resembles a mixture of blood and chloroform; others have pe- 
culiar odors from parts of the body. 

A peculiar fecal smell is experienced from a lunatic or hypo- 
chondriac, very nearly the same as is experienced from patients 
who suffer from habitual constipation. 

The uriniferous odor of uraemia emitted by persons suffering 
from diseased kidney is all-important. 

Malignant cholera can often be detected very early by the 
odor given out by the skin, breath, and stool. 

The odor of the sick-room and of the body of the patient gen- 
erally, the smell of the breath, the sputa, urine, faeces, sweat, 
ulcers, are utilized for diagnosis and treatment. 

The cadaverous odor is a peculiar earthy smell emitted from 
the body, sometimes as early as two weeks before death, in other 
cases a few days. 

The smell of diphtheria is pungent, and is never forgotten. 

The chloroform odor of the breath in diabetes is most signifi- 
cant. 

WEIGHT OF THE BODY. 

The average weight of the body at birth is about seven and 
one-half pounds. We meet with cases frequently over twelve 
pounds and as low as two pounds in living children. But when 
the average male completes the twenty-fifth year of his age, 
growth has reached its maximum, but not weight. The general 
weight consistent with good health and stature should be as 
follows : 



Stature. 






Mean Weight. Weight Increased 7 per cent. 


5 ft. 1 in. 
5 " 2 " 






120 pounds 
126 " 






128 pounds. 
135 " 


5 " 3 " 






133 






142 " 


5 " 4 " 






139 " 






149 " 


5 " 5 " 






142 






152 " 


5 " 6 " 






145 






155 " 


5'" 7 " 






148 






158 " 


5 " 8 " 






155 " 






166 " 


5 " 9 " 






162 






173 " 


5 " 10 " 






169 " 






181 " 


5 " 11 " 






174 " 






186 " 


6 " , . 






178 " 






190 " 



62 DIAGNOSIS. 

If greater than the allowed seven per cent., it affects the vital 
capacity, and respiration becomes diminished. Clothes average 
about one-eighteenth of the weight of the body in autumn and 
early spring. Loss of weight is indicative of phthisis, bron- 
chitis, nervous dyspepsia, and other exhausting diseases. 

CHARACTER OF THE URINE. 

In hysteria, and ansemia of the spinal cord due to self-abuse, 
the urine is remarkably pale, limpid, and abundant, with a very 
low specific gravity, — 1006 or 1010. 

In all fevers and inflammations it is scanty, high-colored, 
and loaded with uric acid, the result of excessive waste of tissue, 
which deposits on standing. 

If very scanty and much acid, there is a very copious brick- 
dust deposit. 

In disordered liver it gives a red stain to the vessel. 

In jaundice the presence of bile gives it a dark porter color. 

If blood is mixed with urine, it has a smoky color when acid ; 
a pinkish hue when alkaline ; quite crimson when much blood 
is passed. 

The greatest amount of acid in urine is to be found in acute 
rheumatism or the uric acid diathesis. Urine when it deposits 
a white limy or calcareous matter denotes nervous disease or 
the alkaline diathesis; if it contains pus there must be ulcera- 
tion either in urethra, bladder, or kidneys. 

In melituria or diabetes, urine very copious, increased be- 
yond the amount of fluids taken, loaded with grape sugar, and 
usually of a very high specific gravity ranging from 1035 to 
1065, but in rare cases it is very low and still sweet. 

Healthy or unhealthy urine may have a peculiar aromatic 
smell, which may be affected by many articles of food or med- 
icine, such as asparagus, garlic, cubebs, turpentine, copaiba. 

Urine voided in the twent3 r -four hours in a man of average 
height free from disease, averages about thirty ounces in the 
summer, and forty in the winter. It should weigh about fifteen 
per one thousand parts more than distilled water. 

If the kidneys are weak it may be highly albuminous, which 
can be readily detected by boiling, which coagulates the albu- 
men. 

In disease of the brain it maybe loaded with a white floury 
substance, which can be precipitated by a solution of nitrate of 
silver. 

Albumen is found in the urine in conditions of weakness, 
irritation, and collapse of the kidney, and also in diseases of the 
blood, as anaemia, purpura, and is easily detected by boiling the 
urine in a tube, when, if albumen be present, it will become 
milky or cloudy; then add a few drops of nitric acid, which will 



DIAGNOSIS. 63 

clear the urine and coagulate the albumen into a mass. Its 
quantity can also be ascertained in the same manner. 

Phosphates and Chlorides represent- waste of brain and 
bone, and are present to a certain extent in all urine, but are 
greatly in excess in all nervous diseases, as epilepsy, chorea, 
masturbation, paralysis, white softening of the brain, and other 
states. When very excessive they appear as a white cloud in the 
urine, or in a copious white flour or gritty deposit in the bottom 
of the vessel. 

They are easily detected and their quantity estimated by boil- 
ing an ounce of urine, and adding a solution of nitrate of silver 
in the proportion of sixty grains to the ounce of water, which will 
precipitate the entire amount of phosphates in the urine, when 
the excess must be deducted from the normal amount, which 
will indicate the condition of nerve-waste or nerve-tire or ex- 
haustion present. 

Pus is only present when there is suppuration in the kidney 
from a stone, or from ulceration of the bladder, or catarrh, or a 
gonorrhoea, and is easily detected by boiling the urine and add- 
ing some liquor potassre, which will coagulate the pus into a 
gelatinous mass. 

Sugar in the urine does not indicate disease of the kidney, 
but rather of the liver, pancreas, or more especially of the co- 
ordinating chemical centre in the brain, — in some cases to over- 
feeding; and for domestic purposes can be easily ascertained, 
if it exists, by placing the chamber with the newly evacuated 
urine in a warm place, keeping it at 80° Fah., and adding a 
teaspoonful or more of yeast; effervescence will soon take place, 
a brisk discharge of gas ensues, and a yellowish liquid is formed, 
which has the odor of beer, and by distillation yields an alco- 
holic liquid. The quantity of sugar present can be estimated, 
since every cubic inch of carbonic acid gas given off by fermen- 
tation corresponds to one grain of sugar, so that the quantity can 
be readily approximated. 

Bile in the urine is likely to be present in disease of the liver, 
and it may be necessary to distinguish it from certain color 
principles as rhubarb and santonine. Dip a white rag into 
urine that contains bile, it is at once colored yellow. Pour a 
little urine on a sheet of writing-paper to form a very thin 
layer and let one or two drops of nitric acid drop on it. If bile 
be present, green and pink colors will show themselves around 
the drop. This can be confirmed by mixing a little muriatic 
acid with the urine and then adding a few drops of nitric, and 
a change of colors, of yellowish-green, green, blue, violet, red, 
occurs. 

Uric Acid in excess represents rapid waste of the nitroge- 
nous elements, as in fever and inflammation, but a supply of 



64 



DIAGNOSIS. 



nitrogenized food greater than what is required for the repair 
of the tissues, such as excessive indulgence in animal food, too 
little bodily exercise, isolation, monotony, sameness, deficient 
aeration of the blood; and also an insufficiency of gastric juice 
is easily detected by the blue litmus-paper being turned red by 
the brick-dust sediment in the chamber- vessel. 

MICROSCOPE. 

A thorough knowledge of all the tissues of the body, its nor- 
mal and abnormal secretions, is necessary for diagnosis with 
the microscope. An instrument of small power is the most 
useful, say from 250 to 300 diameters, one whose adjustment is 
easy, so that an object can be readily detected. It is of great 
utility to detect diseased germs in the secretions, especially in 
discharges or scrapings. For example, by scraping the tongue 
in all cases of mal-assimilation, we can see the bacteria; in 
typhoid fever, the vibrios; in diplitheria, the oidium albicans; 
in the discharge from the nose in catarrh, the amoeba; in the 
urine, the germs of cancer, and in the sputum, those of tubercle. 
Most invaluable, and one which the uninitiated in medical 
science can readily and at once appreciate. 

VITAL CAPACITY OF LUNGS. 

To test correctly it must be clone by a spirometer, an instru- 
ment used to measure the volume of air expired from the 
lungs. Quantity expired after the most complete inspiration is 
the total volume of vital capacity. The vital capacity increases 
with stature and is considerably affected by weight. The ca- 
pacity to breathe is affected most by phthisis. The following- 
table shows the capacity in health and in the three stages of 
pulmonary consumption: 



f 


Capacity in Health. 


Capacity 


in Consumption. 


Height. 


Cubic Inches. 


First Stage. Second Stage. 


Third Stage. 


5 ft. 


1 in. 


. 174 . . 


. 117 . . 


99 . 


. 82 


5 " 


2 " 




182 . . 


. 122 . . 


102 . 


. 86 


5 " 


3 " 




190 . . 


. 127 . . 


108 . 


. 89 


5 " 


4 " 




198 . . 


. 133 . . 


113 . 


. 93 


5 " 


5 " 




206 . . 


. 138 . . 


117 . 


. 97 


5 " 


6 " 




214 . . 


. 143 . . 


122 


. 100 


5 " 


7 " 




222 . . 


. 149 . . 


127 . 


. 104 


5 " 


8 " 




230 . . 


. 154 . . 


131 . 


. 108 


5 " 


9 " 




238 . . 


. 159 . . 


136 . 


. 112 


5 " 


10 " 




246 . . 


. 165 . . 


140 . 


. 116 


5 " 


11 " 




254 . . 


. 170 . . 


145 . 


. 119 


6 " 


a 




262 . . 


. 176 . . 


149 . 


. 126 


To 1 


best the ^ 


rital capacity, a man should stand in 


the erect 


posture, take as 


d< 


>ep an inspiration as possible, at the termma- 



DIAGNOSIS. 65 

tion of which the tap should be turned off by the operator and 
the vital capacity can be traced off the scale. It is not for one 
moment to be supposed that the lungs are emptied of air, as 
there always remains a certain proportion called residual air. 

The vital capacity is greatly diminished in bronchitis, em- 
physema, pneumonia, as well as in consumption and in disease 
of heart and viscera of the abdomen. 

Spirometer. — An instrument for measuring the volume of 
air expired from the lungs. Females measure less than males, 
and in either sex the lung-capacity decreases after fifty. The 
quantity of air expired after complete inspiration is termed the 
vital volume or capacity. This increases by stature. Obesity 
diminishes the breathing capacity ; so also does any abnormal 
condition which interferes with the mobility of the thorax or 
the inflation of the lungs. Effusion into lung-structure is the 
most prominent of all forms of obstruction. Every inch of con- 
solidated lung insures a decrease of forty cubic inches of air by 
measurement, and should have immediate attention. 

ELECTRICITY, 

As a means of diagnosis is of rare value. The best mode of 
application is by or through wet sponges. The positive pole 
in all cases should be applied to the origin of the nerve, and 
the negative to the other end. By placing the positive at the 
nape of the neck, the centre of all nerve-supply to the body, 
and the negative over the chest and abdomen, any weakness 
or tenderness can readily be detected; or, running it down the 
spine, any loss of vitality in any special nerve can be recog- 
nized by a soreness, or burning, or tenderness over it, and the 
disease located in the cord and organ to which the nerve 
branches. It is particularly valuable in recognizing the dis- 
eases of muscles, especially any tendency to fatty degeneration. 
In placing the positive pole at the origin of a muscle and the 
negative at the other end, the muscle if healthy will knot or 
contract in the centre. The battery must be of sufficient power. 
The points which it elucidates are the tenderness and soreness 
of weakened parts, and behavior of the muscles. Still it is 
capable of defining precisely obscure forms of paralysis, whether 
due to effusion or white softening. 

In diagnosing paralysis, it is well to test the sound side first, 
then the affected side, and compare the result. Keep the two 
poles on the muscles about four inches apart; the positive to 
the origin, and the negative to other end, then the contracti- 
bility can be compared. 

In Hemiplegia due to effusion, the paralyzed muscles lose 
their contractibility at once ; in that due to white softening, by 
degrees. 



(>6 DIAGNOSIS. 

In Paraplegia, the condition of the paralyzed muscles is 
similar to hemiplegia. 

In lead and mercurial paralysis, the contractibility remains 
after the power of voluntary motion is gone, or till atrophy has 
set in. 

In rheumatic paralysis, the contractibility is usually normal. 

In progressive muscular atrophy, diminished contractibility 
follows the gradual destruction of the muscles. (See Electricity.) 

THE SPHYMOGRAPH, 

Is an instrument designed to give the curve of the radial pulse 
by tracing. It is strapped on the wrist and is moved by the 
stroke of the pulse. It never can supersede the fingers, but 
as a curiosity or toy is well adapted to deceive the ignorant. 

SPINAL DIAGNOSIS. 

The method of diagnosing disease of the chest and abdomen 
by mapping out a seat of irritation or anaemia of the spinal cord 
is old and empirical. It consists in either applying a sponge 
pressed out of hot water, or the electrode of a battery, or pressure 
with the fingers in the intervertebral spaces. If a tenderness or 
weakness or irritation can be detected, then it is supposed that 
there is lost vitality in the nerve or nerves that emanate from 
that point, and the organ in chest or abdomen that the nerve 
supplies suffers from diminished vitalit}^ or disease. The irri- 
tation or disease in an organ is carried to the cord, which is a 
reflex centre, sets up an irritation there, and a tenderness or 
weakness can be detected. In hysteria, masturbation, and other 
anaemic conditions of the cord, such points are said to exist. The 
method has no merit, neither is it reliable, but often subserves 
the ignorance of the charlatan. 

LONGEVITY. 

By this is meant the mean number of years which at any 
given age the members of a community, taken indiscriminately, 
may expect to live. An easy rule, and one very generally 
adopted by life insurance agents, has been established for de- 
termining this fact, and corresponds very closely with our best 
statistics. The criterion or rule for determining this is : The 
expectation of life is equal to two-thirds of the difference be- 
tween the age of the individual and eighty. Thus, a man is 
twenty years old, sixty is the difference between this age and 
eighty ; two-thirds of sixty is forty, and this is the sum of his 
expectation. By the same rule a man of sixty will have a lease 
on life for fourteen years ; and a child of five for fifty years. 

Another method of testing the longevity is by drawing a 
piece of thread from the outer corner of the eye to the centre of 



DIAGNOSIS. 67 

the prominence at the back portion of the head (the occipital 
protuberance), taking the opening or meatus of the ear as the 
index. If the opening is below the line, and for every degree 
below, strong vital tenacity, — a degree of vital force that will 
weather grave disease; if the opening is on the line with the 
cord, vital force is very weak, little power of resistance to ward 
off morbid action ; if the opening is above the cord, the slight- 
est, most trivial disorder will cause death. The natural atrophy 
or shrinkage of the brain in old age and in whiskey-drinking 
is often remarkable, and exhibits the veracity of this line or 
angle. 

TEMPERAMENTS. 

The Caucasian race, wherever met, range themselves under 
temperaments. There are a great variety, but for all useful 
purposes they may be divided under four classes, two vital and 
two non- vital. 

1. The Sanguine. — A vital temperament in which there is 
a florid complexion, expanded chest, great vivacity of disposi- 
tion, strong tenacity of life, a most hopeful mind, progressive, 
exhibiting a preponderance of the vascular system, circulation 
full, strong, vigorous. 

2. The Bilious. — A very vital temperament, sallow skin, 
,dark hair, progressive, muscular system well knit, remarkable 

for the compactness of fibre, indicative of great strength, endur- 
ance, and activity. 

3. The Nervous. — A non-vital temperament, in which the 
nervous system has been developed at the expense of the phys- 
ical features; white, sharp outline, irregular and vivacious ac- 
tivity; great susceptibility to impressions ; a predominance of 
the nervous over all other functions; complexion may be either 
dark or fair. 

4. Lymphatic. — A non-vital temperament created by civ- 
ilization, and excess in eating and drinking more than the wants 
of the economy demand. The face is round, soft, and full, the 
abdomen large, and circulation languid. Although there is no 
distinctive vital temperament in other races, still the Indi- 
American, Mongolian, and Negro, when brought in contact 
with the vices of civilization, rapidly acquire the non-vital tem- 
perament and thus become extinct. 

It is a well-known physiological law that if the respective 
parties to a marriage are similar or identical in temperament, 
so that no appreciable difference exists, sterility will be the result 
of the marriage, even though they be dissimilar in appearance; 
if they are made up of portions of the same temperament their 
union would be incompatible. The maintenance, perpetuity 
and vigor of the white race is inherent in the vital tempera- 



68 DIAGNOSIS, 

merits ; without their agency there could be no stamina nor 
vital attributes. The non-vital, nervous, and lymphatic are 
great deteriorations, the effects of high civilization and excess. 

They have no diagnostic complexion ; if they are of a bilious 
temperament they will be dark, if of a sanguine, fair. The 
non-vital possesses a very feeble vitality; still, when combined 
with one of the vital temperaments, may give us a useful speci- 
men of humanity. If the non -vital marry, whether it be nerv- 
ous and lymphatic, or nervous, and nervous, no procreation of 
an offspring: it will die out, as the tendency is to extinction, as 
the race cannot suffer deterioration. The production and pre- 
vention of the non-vital temperaments is an important field of 
scientific investigation, involving the well-being and perpetuity 
of our race. 

The greatest differences that can be obtained between the 
respective sexes within the race between the vital tempera- 
ments is the most favorable for a large, long-lived, energetic, 
civilizing family, — the difference is essential for a healthy off- 
spring. All marriages in antagonism to this law will entail on 
the children some unfortunate result. Children born from par- 
ents partly incompatible possess a feeble organization, which 
is liable to yield to the simplest forms of diseased action, and 
it is here that a scientific practitioner is so frequently baffled 
— his best resources of no utility, for in its very birth, blood, 
tissue, organization, disease and death are stamped, the product 
of incompatible marriage. 

It is unnecessary to repeat that races are antagonistic and 
distinct, that marriage should never be consummated outside of 
the race, for if it is, and there be offspring, that progeny will 
be tuberculous and will inevitably die out. It is simply a dete- 
rioration to both races concerned in the effort, and should be 
prohibited by the most rigid legal enactments, and not counte- 
nanced by a set of pseudo-fanatics. 

Modern clinical pathology enjoins on every one treating dis- 
ease, the necessity of a careful examination of the patient. Often, 
indeed, correct diagnosis, and consequently treatment, depends 
on the performance of this duty. Exact elucidation of the case 
is always necessary, as neglect of the presence or absence of a 
single point may be of grave importance. 

To recognize disease by some or all of the rules laid down, is 
the object of this article. 



DISEASE. 69 



DISEASE. 



Disease may be defined as a deviation from health, or a par- 
tial death either of a part or of the entire body. Some would 
define it as a want of equilibrium between the positive and neg- 
ative forces of the body; others a difference between the solids 
and fluids. The aim or object of all treatment in disease is to 
aid nature to promote a renewal of life. 

SHOCK, PROSTRATION, COLLAPSE. 

A state or condition that signifies great depression of vital 
power, liable to follow any accident, injury, or concussion, or 
inhalation or absorption of any poison, or any depressing pas- 
sion or excess. 

Symptoms are very variable. Most commonly however, we 
find the patient lying on the back, with a cold skin, feeble 
pulse, signing respiration, half unconscious. If the force of the 
shock or injury, or poison, has fallen upon the vascular system, 
there will be syncope or fainting, pulse and respiration imper- 
ceptible; if upon the nervous system, patient bewildered, inco- 
herent, vomiting, coma, convulsions, paralysis of sphincters. 

The duration of the stage of prostration is variable, depend- 
ing on the power of vital resistance inherent in the patient and 
the amount of violence inflicted or poison absorbed or degra- 
dation of living matter, commonly from a few to forty-eight 
hours. 

The mode or manner of recovery from shock or collapse is 
termed reaction, — everything depending on the nature, degree, 
or quality of that reaction. If, aided by proper means, it is 
perfect, we have recovery; if in spite of our best efforts it is 
altogether wanting, we have death ; if it is imperfect, then it is 
followed by fever, a salutary effort of vital force for recovery. 

The indications in treatment are to stimulate vital forces to 
healthy reaction. If the patient is cold, shivering, respiration 
and pulse feeble, diffusible stimulants should be administered, 
such as brandy and water, or capsicum, or some preparation of 
ammonia ; if incapable of swallowing, the same remedies should 
be administered by the rectum in an emulsion of slippery elm, 
and spirits of turpentine added. The patient should be bathed 
all over with ammonia and warm water, after which he should 
be well dried and rubbed with dry mustard. If no reaction is 
perceptible, dry cups or scorching hot pillows should be ap- 



70 FEVER. 

plied to both sides of the spine, and mustard plasters with heat 
to the feet. Rubbing the skin is of the greatest importance, as 
we thereby stimulate the periphery of nerves, which stimulus is 
carried to the brain. Artificial heat by means of bricks wrapped 
in flannel, or bottles of hot water, should be applied all around 
the patient's body, especially inside of arms and thighs. Stim- 
ulation must be persevered with, and other remedies, such as 
quinine, resorted to, the object being to establish an equili- 
brium in the body, and the greatest care should be observed 
not to over-stimulate, as we thereby produce exhaustion with 
cerebral excitement. What is desired is perfect reaction, so 
that fever, the condition of imperfect reaction, may be obviated. 



FEVER. 



Fever is a condition of imperfect reaction, — a salutary effort 
of nature at elimination or repair, — an effort of impaired vital 
force at restoration. 

The common causes of fever are the action oi heat and cold, 
mechanical injuries of all kinds, poisons, disease-germs whether 
degradations within the body or the result of contagion and 
infection, malaria, depressing passions, over-crowding, sewer- 
gases, &c- 

The ordinary symptoms of fever are languor, lassitude, de- 
bility, pain in the head, back, and calves of the legs, rigors, 
high heat, frequent pulse and respirations, with derangement 
of the secretions. 

The poison or living germinal matter that produces these 
symptoms may have gained access to the patient's body through 
the air, or water, or food, or it may be the degraded or changed 
living matter of his own body. The salivary glands of the 
mouth are the most eligible channels of a poison gaining access 
to our bodies. This is apparent by the disturbance of the stomach. 
Once the poison has gained admission and found its way into 
the blood, it grows with great rapidity, and is diffused through- 
out the entire body, disturbing the vitality of organic living 
matter with which it comes in contact. The destruction caused 
by fever or germ-disease involves every constituent of the body. 

General nervous depression is the characteristic of all fevers. 
The prostration, rigors, headache, with pain in the back and 
calves of the legs, denote a partial death of the nervous system. 
Pain exists in every sensient nerve in the body, but is experienced 
most keenly by the patient in the large superficial sensient 
nerves of the back and calves of the leg. In fever we have a 
diminution of evaporation, the dormant skin does not act as a 



FEVER. 71 

refrigerator, destructive metamorphosis is great, the semi-vital 
chemical changes raise the temperature, — there is rapid oxida- 
tion, the passage of organic into inorganic matter, the blood 
loaded with germinal matter, together with the irritation of 
brain and the eighth pair of nerves that supply the liver, caus- 
ing an excessive secretion of glucose, all of which go to explain 
the heat of fever. 

The controlling action of the brain being impaired, the heart 
and lungs are irritable, and their action accelerated. The brain 
needs more vital force to hold them in check. All the secre- 
tions and excretions are depraved. 

The termination of fever is either recovery or death ; the 
former may in some cases be imperfect, terminating in other 
forms of disease, as anaemia, paralysis, &c. 

Some fevers, due to disease-germs, a specific contagion, have 
a definite period of existence in the body, which limits their 
duration. Nearly all contagious diseases are of this class. 

Fevers are easily recognized by their symptoms : languor, pain 
in the head, back, calves of legs, rigors, with high heat, frequent 
pulse and respirations, with perverted secretions. 

If the heat of fever does not exceed 103° Fah., with favorable 
surroundings, hygiene, nursing, and no irreparable lesion, good 
hopes may be entertained of rapid recovery. 

Treatment. — The indications of treatment are based upon 
one fundamental rule: stimulating the vital forces to healthy 
reaction. See where vitality is wanting, and aid in supplying 
it. These may be more definitely expressed as follows: Toad- 
minister remedies to diminish heat, pulse, and respirations, 
maintain vital force, destroy poisons or disease-germs that are 
the chief factor of the fever, and excite all glands to healthy 
action. 

In the incipient stage of all fevers, ven T great benefit is derived 
from an emetic to unload the stomach, an active or gentle ca- 
thartic to relieve the bowels, and an alcoholic vapor bath or 
some form of bathing to start the function of the skin. 

The utility of an emetic is apparent: the poison that prob- 
ably caused the fever has been taken in by the salivary glands, 
swallowed, and lowers the vitality of the stomach. It loathes 
food, fails to digest, and the symptoms are much ameliorated 
by an emetic. Before administering this, the patient should 
drink freely of tepid water with a small amount of bicarbonate 
of soda, so as to neutralize the acid secretion from the walls of 
the stomach. Following the emetic, the alcoholic vapor bath, 
then the cathartic. Typhoid fever is the solitary exception 
among all fevers to the use of purgatives ; in that fever they are 
not admissible, except in some rare instances. 

If the patient is unable to sit up or very young, or pregnant, 



72 FEVER. 

instead of the alcoholic vapor bath, sponging the entire body 
should be resorted to with tepid alkaline water. In some cases 
vinegar is a good addition. 

Then the regular treatment for the case should be laid down. 

The room selected for the patient during his illness should, 
if possible, be isolated, well ventilated, no draught, abundance 
of light, free from carpets, curtains, and paper on the walls, as 
they retain the seeds of disease. If possible, an open fire- 
place, and if the season permits, a fire, so as to destroy the disease- 
germs as they escape from the patient. If convenient, two beds 
should be placed in the apartment, so that the patient's cloth- 
ing and bed-clothing can be changed daily, and he lifted from 
one bed to the other. In all cases the head of the bed should 
be placed to the north, feet to the south, and insulated from 
the floor with glass castors or pieces of glass, so that the patient 
may be in unison with the magnetic law of the earth. The 
greatest cleanliness should be observed. When clothing and bed- 
clothing are removed, they should at once be immersed in water 
with an antiseptic. No unused food should be permitted to 
remain in the room. Antiseptics, such as chloride of lime 
or carbolic acid, buckets of water with bromine, or iodine, or 
permanganate of potassa, should be exposed in different corners 
of the apartment. If a nurse is to be selected, let her be young, 
strong, vigorous, — few attendants except the nurse, so that the 
contagion be limited as far as possible. All superfluous matter 
should be kept away from the patient, even books. Magazines 
and papers should never be permitted to get out; after perusal 
they should be destroyed. In all cases the hair should be cut 
short and the cut portion destroyed or deodorized. The recum- 
bent posture is the true one, it retains the nervo-vital fluid in 
the spinal cavity and not in the cranium, and gives a diminu- 
tion of pulse of at least ten or twelve beats per minute, with a 
corresponding lowering of heat and respirations. The entire 
body should be sponged three times daily with an alkaline wash 
such as castile soap and warm water, or bicarbonate of potash 
and tepid water, well dried, and then rubbed with the dry hand. 
It is sometimes beneficial to follow this with vinegar and water, 
which is cooling and grateful to the patient and excites the 
normal alkaline secretion from the skin. The alkaline bathing 
removes the disease-germs, opens up the emunctories of the 
skin; the rubbing with the dry hand dislodges the disease- 
germs from the capillaries, removes the stagnation in the micro- 
scopical circulation, and the reflex effect of it is highly vitaliz- 
ing to the medulla oblongata, the seat of reflex action and life. 
Besides, the inherent vitality of the nurse is in this manner com- 
municated to the patient, so that instead of elderly ladies being 
selected for nurses, we demand the young and healthy. The 



FEVER. 73 

law of reflex emanation is definite: we assimilate the vital con- 
dition of those with whom we are brought in contact. 

In exhausting fevers,, like typhoid, good results are derived 
from the inunction of warm olive oil after the sponging and 
drying off. This aids nutrition, supplies the place of arrested 
sebaceous follicles, and softens the skin, for exhalation attracts 
the germs to the surface. Oil is perfectly compatible in the 
living tissues. 

Physiological chemistry explains the imperative necessity of 
drink in fevers. "Water requires to be in excess of the demand; 
acidulated drinks of water, with a few drops of acetic or hydro- 
chloric acid, enable the albumen to be acted on by the gastric 
juice. All acid substances have the power of increasing the 
normal alkaline secretions of the body. 

Apply heat to the feet in all cases of fever, for though the 
action of the heart is violent yet it lacks the stamina or power 
to send the blood to the capillaries; besides, the nervous system, 
upon which the circulation depends, is incapable of performing 
its function in aiding the circulation, and artificial heat aids in 
a renewal of life. As to the clothing of the patient, cotton and 
linen should be avoided, and woolen or silk preferred as con- 
servators of vital force and being impervious to atmospheric 
changes. 

In fever the nitrogenous tissues are devitalized, drained away, 
and it is important that they should be replaced, so that small 
doses of nitrogenous aliment should be given frequently. These 
pass over the irritated stomach unconsciously, and are taken 
up by the lacteals in the intestines, requiring very little to make 
them fit for absorption. The most suitable food is milk. It 
forms the most appropriate nourishment for fever patients. 
Two to three ounces should be given every two hours with half 
a teaspoonful of lime-water. If it disagrees, substitute beef tea 
for the milk. If the patient is properly nourished, it renders 
the danger much less. Albumen, such as we possess in eggs 
and oysters, is highly nutritious if quickly absorbed, but if 
delayed as they are likely to be by the impaired condition of 
the stomach, their decomposition is highly injurious, — the sul- 
phureted hydrogen and other gases evolved are so poisonous 
that an aggravation of symptoms is the result. A good condi- 
tion of gastric power is necessary for the digestion of eggs and 
oysters. 

Alcohol is a poor stimulant : it has no food or blood-forming 
faculty ; its only property in fever is an arrester of destructive 
metamorphosis or change, so with reference to its use in fevers 
we must be guided by the amount of disintegration going on. 
If there is great prostration, low muttering, delirium, excessive 
phosphatic elimination by the kidneys, it should be given. It 



74 FEVER. 

acts well if there is tremor of the muscles, a sharp, weak, un- 
equal pulse, or rapid respiration. 

Sleep is most essential in fever. It is only during sleep that 
the brain picks up its nutrition or pabulum from the blood. 
There is no nutrition without sleep. 

In our pathology of fever we must bear in mind that we have 
a condition of nervous depression, and in order to meet this we 
must use, in aiding the salutary efforts of nature, cerebral stim- 
ulants, or, as they are termed, arterial sedatives, such as aconite, 
veratrum viride, green root tincture of gelseminum, digitalis, 
belladonna, &c. They not only stimulate the brain, but relax 
the capillaries and skin, and under their use heat, respiration, 
and pulse diminish. Antiseptics in all cases should be admin- 
istered, as they tend to destroy disease-germs and in this way 
are of the greatest utility in all fevers. General treatment ac- 
cording to the condition present, convalescence in all cases being 
established upon tonics, nutritious food, fresh air, and sun- 
light. 

Fevers are usually divided into two great families, idiopathic 
and traumatic. The former term is applied to all that originate 
within the body ; the latter to surgical fever, — that symptomatic 
of an injury. The proper division is into continued, intermit- 
tent, remittent, eruptive, and surgical. 

INFLAMMATION. 

Fever is a partial death of the entire body; inflammation is 
a local fever, and involves only a portion of the body. Inflam- 
mation then is a partial death or a condition of vital depression 
of a part or some organ of the body. 

Causes. — Anything that tends to diminish, damage, or de- 
stroy the vitality of a part of the body, such as heat, cold, wet, 
poisons, mechanical violence, (fee. 

The permanent symptoms are pain, heat, redness, and swell- 
ing. 

Pain is a symptom of partial death, of deficient vitality, or vital 
depression. It differs in structures and tissues according to their 
physiological function, chemical composition, and anatomical 
structure. 

The nerve-tissue being intrinsically the most valuable, most 
highly organized, and vital, is the most resisting, the most dif- 
ficult to depress, and when once devitalized the most tardy of 
all structures to regain its vitality. The pain also, when it 
suffers a partial death, is out of proportion to all other pain, 
especially so if the brain has suffered the shock: here it is frontal, 
and aggravated by noise, light, heat, and motion. 

If the skin suffers a partial death or inflammation, the pain 
is burning, tingling ; if the cellular tissue, thr obbing ; if the serous 



FEVER. 75 

membranes, like pleura, sharp, lancinating ; if the mucous mem- 
branes, sore, raw; if in bone, dull, deep-seated; if in cartilage, 
more intense. Pain may not be experienced in the inflamed 
part, but reflected by recurrent nerves to a part at a distance, 
as for instance, in inflammation of the liver the pain is in the 
shoulder; of the kidney, at the orifice of the urethra; of the ovary, 
in the front of the thigh ; of the uterus, in the sacrum ; of the 
hip-joint, at the knee. 

The heat of inflammation is caused by the semi-vital chem- 
ical change, the passage of organic into inorganic matter, the 
perversion of nutrition, rapid oxidation, molecular excitement, 
and general metamorphosis of structure. 

The congestion and redness are due to the lost contractility 
of the walls of the blood-vessels, whereby their walls become 
loose and lax, — the blood rushes in and the minute capillaries 
being also relaxed, red blood circulates where white only passed 
through, and the walls being so relaxed the more watery por- 
tion passes through their walls. The blood-vessels owe their 
contractility to the nerves that supply them, so the vitality 
of the part or its nerves being so weakened permits of the 
changes; indeed, its chemical character is altered, — in health 
neutral or alkaline, it is in inflammation intensely acid. 

Besides a change in secretion, there are important changes 
in the structure of the part, as degradation of living matter into 
disease-germs which cause it to spread. 

Inflammation has but one genuine termination, — resolution 
or recovery, — the subsidence of the inflammation and the resto- 
ration of the part to its original condition ; but besides this le- 
gitimate termination, there may take place from various causes 
the following effects, viz.: Effusion of serum; effusion of blood 
or hemorrhage; effusion of lymph; the breaking of lymph and 
formation of pus; ulceration; gangrene, or mortification. 

Inflammation may be either acute or active, sub-acute or 
passive, and chronic. It is called acute when it sets in and 
runs its course rapidly, when the symptoms are all well defined 
and are accompanied with rigors and a fever; sub-acute, same as 
the acute, with the exception that there is no fever. Chronic 
may be either a sequel of an acute or sub-acute attack, or it 
may come on per se. It is liable to occur in patients of low vi- 
tality. It usually progresses slowly, insidiously; symptoms not 
well defined; no fever, and has a tendency to terminate in effu- 
sion of serum or thickening. 

The permanency of the pain, heat, redness, and swelling is 
the best point by which to recognize inflammation. 

The correct treatment of all inflammation is powerful local 
and internal stimulation. Local stimulants of such power should 
be applied as will speedily cause a renewal of life in the part, 



76 FEVER. 

so as to obviate the condition of pain, induce contractility of 
blood-vessels, and overcome partial death ; internal stimulants, 
as aconite, veratrum viride, gelsemium, digitalis, cinchona, that 
tend to equalize the action of the heart and arteries by impart- 
ing tonicity to the brain; and antiseptics in case of grave inflam- 
mation, for in all its varied forms there is a degradation of the 
normal living matter concerned innutrition into bacteria, which 
must be guarded against. It should be laid down as a rule in 
practice in inflammation, that if local stimulants are insufficient 
to give an amelioration of pain, then the impressibility of the 
sensorium must be blunted by opium or other anodynes, the 
rule being an entire freedom from pain must be secured. 

General attention should be directed to hygiene, rest, diet, 
sponging, and secretions. 

Effusion of Serum may occur during inflammation of any 
tissue, but by preference from serous membranes, as the perios- 
teum, membranes of the brain, the pleura, and peritoneum ; the 
cellular tissue is also obnoxious to serous effusions. When ef- 
fusion of serum takes place, whether it be from membranes of 
the brain, pleura, peritoneum, or cellular tissue or other struc- 
tures, it constitutes what we term dropsy, not a disease, a mere 
mechanical effect. Serous effusion, however, often gives rise to 
much trouble, especially if within the cranium, chest, or abdo- 
men; in the extremities it constitutes what we term oedema or 
dropsy, pitting upon pressure. Although not a disease, its 
presence is liable to bring about grave complications, and it 
must be got rid of at the ver} 7 earliest moment the inflammation 
can be overcome. 

To get rid of serous effusion, the appetite should be stimulated 
with tonics, as teaspoonful doses of compound tincture of cin- 
chona, before meals, and the very best of blood-elaborating diet 
given. Before making any decided attempt at the removal of 
the dropsy, place the patient upon an infusion of digitalis for a 
few days. To half a pint of water, boiling briskly, add one or 
two grains of fresh pulverized digitalis, boil for five minutes, 
then cool and administer one wineglassful every two or three 
hours; continue from day to day till the patient becomes quite 
melancholy or despondent, then administer less frequently and 
in smaller doses. Now is the opportune moment to commence 
with diaphoretics, diuretics, and hydragogue cathartics, just as 
the digitalis has unlocked the flood-gates of the body. Then 
take of 

Pulverized mandrake, thirty grains; pulverized nitrate of 
potash, one drachm; cream of tartar, one ounce. Mix. 

Make ten powders, and let the patient take two or more daily, 
so as to cause at least three watery evacuations from the bowels 
in the twenty-four hours. In addition, a teaspoonful of the fol- 



FEVER. 77 

lowing mixture should be taken thrice daily, in a glass of 
water : 

Camphor water, four ounces; nitrate of potash, half an ounce ; 
muriated tincture of iron, one ounce. Mix. 

At the same time an alcoholic vapor bath should be given 
every other day. As a drink to encourage free sweating, an in- 
fusion of jaborandi or pleurisy-root. Patient kept moderately 
warm and clothed in flannel. 

If the above means fail, discontinue the mandrake mixture 
and substitute a pill, one-twelfth of a grain of elaterium. If the 
patient is unable to bear such active remedies, five-grain doses 
of iodide of potassium should be given in a tablespoonful of 
fluid extract of saxifraga. 

Treat effusion or dropsy in the extremities in the same man- 
ner, with the addition of rest, elevation, compression by rollers, 
friction, shampooing, steaming with medicated vapors, elec- 
tricity. (See Dropsy.) 

Effusion of Blood. — Hemorrhage, as a result of inflam- 
mation, may take place prior to or during its activity; or the 
inflammation may so terminate. 

Organs that are freely supplied with blood-vessels, when they 
suffer a partial death are more liable to have hemorrhage occur 
in them than others, — as the lungs, stomach, bowels, kidneys, 
bladder, urethra, uterus. 

In the treatment of hemorrhage as a result of inflamma- 
tion, the main point is more thorough arterial sedation, more 
active local stimulation. 

If from the lungs, large doses of veratrum viride ; if from the 
stomach, rectum, kidneys, or uterus, the green root tincture of 
gelsemium, and digitalis. 

If the hemorrhage is violent, styptics may be resorted to, but 
the true principles of treatment of inflammation should never 
be lost sight of. Salt, iron, gallic acid, digitalis, matico are 
useful if from the lungs; capsicum, salt, gelsemium, if from the 
stomach; erigeron, gallic acid, ergot, if from the kidneys or 
uterus. 

In surgical operations, the vessels should be ligated, — still 
there are often minute capillaries that bleed. Then carbolic 
acid spray, exposure of the bleeding surface to the air, pressure 
by bandages, cold, perchloride of iron, matico, spider web. 

Effusion of Lymph. — This is a very common termination 
of chronic inflammation, still there can be little doubt but that 
it is present in all forms. When it takes place, it causes indu- 
ration, thickening, adhesions, mechanical obstructions. 

In surgical practice, the greatest ingenuity has been exer- 
cised to procure effusion of lymph for the purpose of cementing 
or joining parts. For this purpose all foreign bodies are 



78 FEVER. 

removed. Catgut ligatures are used. An antiseptic spray flows 
upon the wound to destroy degraded matter or bacteria. Metallic 
sutures and antiseptic dressing are extensively employed. Effu- 
sion of lymph for the purpose of repair can only take place 
when there is total absence of pain, and when the vital forces 
are normal. Lymph is often effused in general inflammations; 
in pleurisy, where it forms adhesions; in inflammation of stom- 
ach, thickening; in canals, forming strictures; in glands and 
tissues, forming swellings. 

It is highly desirable to get rid of effused lymph, because if 
permitted to remain it is liable to break down at any time the 
vital forces of the individual become impaired, and form an 
abscess. 

To cause an absorption of effused lymph our best internal 
remedies are iodide of potassium, iodoform, bromide of potas- 
sium, saxifraga, phytolacca, blue flag, mandrake. 

Our local remedies are green plantain leaves, phytolacca, stra- 
monium; belladonna, ozonized clay, iodide of potassium, iodo- 
form, potassa, ammonia. Shampooing, friction, and electricity 
are very doubtful in their utility. When adhesions have taken 
place, the continuous application of the irritating plaster is a 
powerful resolvant, and aids in the breaking down or absorp- 
tion of the adhesions. 

The Formation of Pus. — Lymph or plasma from the blood 
is effused to a greater or less extent in all forms of inflamma- 
tion, but especially in the chronic, and is liable at any moment 
there is the slightest nervous depression, to break down and be- 
come pus. This event is invariably ushered in with rigors, 
but when it occurs during acute inflammation, simultaneously 
with the rigors the pain changes to a throbbing or beating, 
the heat diminishes, congestion and redness disappear. When 
it occurs during chronic inflammation or after inflammation 
has ceased, it is also invariably preceded by a rigor. The broken- 
down lymph constitutes pus, and a collection of pus anywhere 
forms an abscess. The precursor or rigor is followed by the 
lymph breaking down in the centre and gradually enlarging, 
perhaps pointing, and a sense of fluctuation is experienced to 
the touch. There are numerous varieties of pus, as, healthy or 
laudable, when it is thick and creamy ; serous, when it contains 
water; sanious, when it contains blood; curd-like or cheesy, 
when it contains tubercle; muco-purulent, when it contains 
mucus mixed with purulent matter ; lardaceous, if like lard ; 
specific, when it contains a special living germ or poison; and 
putrid, when dark or offensive. 

The division of abscess into acute and chronic, superficial and 
deep-seated, explains itself. 

The moment pus has formed, there should be an assiduous 



FEVEE. 79 

effort made to aid the vital forces of the part in its further pro- 
gress by the application of heat and moisture in the form of a 
well-made poultice, which should be continued until the lymph 
has entirely broken when a free opening should be made into, 
the part and the poultices continued for a day or two, then 
dressed with an ointment of vaseline. 

Simultaneously with the evacuation of the pus and breaking 
down of the entire amount of lymph effused, nature begins to 
throw out lymph anew at the bottom of the abscess or cavity ; this 
is at once permeated by blood-vessels and nerves ; then another 
layer which becomes similarly organized, and so on until she 
reaches the surface, when around its edges can be seen a white 
milk}* scum, which gradually covers the entire surface. The pro- 
cess of effusion of lymph, its organization or permeation with 
blood-vessels and nerves, is called the process of cicatrization; 
when it is covered over with a new skin or cutis it is called a 
cicatrix. In order that the effused lymph may exhibit vital 
elements, the process may be devoid of pain, the pus laudable, 
and the granulations neither pale or red. During such a pro- 
cess of repair the vital stamina of the patient should be well 
sustained with good food. 

Gangrene, or Incipient Mortification. — When the vital 
forces of a part are so shattered that the salutary effort of nature 
fails in obtaining resolution, then the process of dying is liable 
to set in. If it is an internal vital organ, the sudden cessation of 
pain following a high intensity of symptoms, with a typhoid 
condition supervening, features becoming small and contracted, 
breath and extremities cold, intermitting wiry pulse, indicate 
the approach of mortification or complete death. 

If the inflammation occurs in an extremity and it is about 
to terminate in gangrene, pain suddenly ceases, the redness be- 
comes of a livid color, the congestion soft and flaccid. It crep- 
itates when pressed upon, from the fact that it contains gases, 
the productions of putrefaction and a train of typhoid symp- 
toms. 

In gangrene, when the parts yet retain a certain degree of 
vitality the object should be to arrest the occurrence of morti- 
fication. Internal stimulants and antiseptics, as orandy and 
quinine, yeast; and locally poultices of charcoal, yeast, capsi- 
cum, wild indigo weed with carbolic acid, changed frequently. 
If this poultice does nothing in arresting the condition it will 
at least stimulate a line of demarcation between the living and 
dying part. Such a line usually makes its appearance in the 
form of a red blush, which soon raises into a blister; this soon 
ruptures, forming a line of ulceration with a furrow. 

In the treatment of all forms of inflammation, the most de- 
cided and energetic measures should be resorted to ; internal 



80 FEVER. 

and local stimulation should be the rule, in order to prevent 
the process of dying (gangrene) or complete death (mortifica- 
tion) from taking place. 

CLASSIFICATION OF FEVERS. 

Much has been written on the classification of fevers. In 
order to be as clear as possible, they may be arranged in the 
following order: 

Simple or continued fever, milk fever- 
Gastric fever. 

Simple bilious fever. 

Intermittent fever, ague, malarial fever. 

Remittent fever simple, remittent bilious and malignant. 

Relapsing fever. 

Typhoid or enteric fever. 

Typhus fever, plague. 

Yellow fever. 

Dengue or break-bone fever. 

Erysipelas. 

Diphtheria. 

Cerebro-spinal meningitis, or spotted fever. 

Puerperal fever. 

Anthrax (giant bacteria.) 

Surgical fever, simple, irritative, intermittent, hectic, and 
typhoid. 

Measles. 

Rotheln or French measles. 

Scarlet fever, simple, anginosa, malignant. 

Smallpox, discreta, confluent, malignant. 

SIMPLE CONTINUED OR EPHEMERAL FEVER. 

A slight depression of the nervous system, with fever, in 
which the vital forces react, sometimes in a day, at other times 
having a variable duration of from a few to ten days. 

The cause is usually cold, wet, exposure, overwork, mental 
depression. 

The usual symptoms are, the patient is seized with lassitude 
and debility, nausea, want of appetite, chilliness, pain in head, 
back, and limbs. After a few hours rigors and a fever, high 
heat, frequent pulse and respirations, headache, thirst, consti- 
pation, dry skin, scanty urine, perhaps slight delirium ; symp- 
toms aggravated at night. After a few days a remission; crit- 
ical sweating or diarrhoea. Convalescence often somewhat slow. 

It usually terminates in recovery. 

It is easily recognized by its cause, mildness, short duration, 
by its common occurrence in children, persons of feeble vital 
force, and nursing women. 



FEVER. 81 

In the treatment the ordinary indications for treatment of 
•fever should be followed. An emetic of the wine of ipecac, pre- 
ceded with copious draughts of tepid water rendered alkaline 
by the addition of half a teaspoonful of bicarbonate of soda to 
the half-pint ; alcoholic vapor or warm bath ; to be followed with 
a teaspoonful of Rochelle salts every two hours, until the bowels 
move freely; rest in bed; sponging; diet, beef tea or milk and 
lime-water. 

The febrile excitement is to be kept thoroughly controlled 
by tincture of aconite, veratrum, and sweet spirits of nitre, one 
teaspoonful of each added to four ounces or half a tumbler of 
water. From half to one teaspoonful administered every hour 
according to the age of the patient, and as soon as heat, pulse, 
and respirations are normal, every two, three, or four hours. If 
breath is offensive, give a tablespoonful of brewers' yeast in 
half a tumbler of sweet milk twice daily. As soon as fever 
abates, administer some good tonic, as port wine and Peruvian 
bark, one ounce of the bark to a pint of wine, or the wine bitters 
in tablespoonful doses thrice daily. 

As recovery progresses, the diet should be generous, so as to 
keep up vital power. Any complications should be carefully 
guarded. It is our mildest type of fever; nevertheless, its urgent 
symptoms should be promptly relieved, as some cases by im- 
proper care merge along into typhoid. 

GASTRIC FEVER. 

So called, because it is induced by a shock to the stomach. 

It is caused by anything that will irritate the stomach of a 
child, as pastry, cabbage, nuts, candies, or alcohol. 

There is a period of prostration, during which the child suf- 
fers from languor, lassitude, debility, nausea, vomiting, followed 
by rigors and a fever, in which the predominating symptoms 
are nausea, vomiting, pain over the region of the stomach ; acid 
or fetid breath, white-coated tongue are always present. 

Its duration is from seven to fourteen days, and if properly 
treated terminates in recovery. 

It is easily recognized by its history, derangement of stomach, 
nausea, vomiting, white coat on tongue, irritation of brain, and 
the entire absence of any other type of fever, and that it is pe- 
culiar to children. 

Treatment. — As soon as recognized, give the little sufferer 
an emetic. The peculiar shape of a child's stomach enables it 
to vomit easily and effectively. To very young children the 
wine of ipecac, to those more advanced in years an infusion of 
lobelia. In all cases precede the emetic with drinks of tepid 
water with bicarbonate of soda, so as to neutralize the acid se- 
cretions of the stomach and permit of an easy absorption of the 



82 FEVER. 

emetic, and a thorough washing out of the stomach ; follow this 
with a warm alkaline bath, then give a teaspoonful of the neu- 
tralizing mixture every hour until a free movement of the 
bowels is obtained. While pursuing the above treatment, acon- 
ite, veratrum, and sweet spirits of nitre should be given as in 
the preceding fever. 

If there is still a disposition to nausea or vomiting, apply a 
plaster made of pulverized cloves, allspice, and capsicum mois- 
tened with vinegar, over the region of the stomach, and give 
milk and lime-water in very small quantities every two hours, 
for diet. Give the stomach all the rest possible ; as a drink, 
boiled water on toast or crackers, or barley-water. 

Several days after the fever has entirely disappeared is the 
proper time for tonics, as the wine bitters, elixir cinchona, sul- 
phate cinchonine. 

Otherwise^ the treatment should be the same as for fevers 
generally, especially insisting upon rest in the recumbent pos- 
ture, and sponging the body thrice daily. 

SIMPLE BILIOUS FEVER. 

A fever induced by a shock to the liver. 

Its common causes are blows, dress irritating the liver, poison 
in blood, as syphilis, and mercury; eating or drinking exces- 
sively of carbonaceous food or drink ; passion. 

The ordinary symptoms are prostration, in which we have lan- 
guor, lassitude, debility, nausea, vomiting, brown-coated tongue, 
yellow skin, pain perhaps over the region of the liver or in the 
shoulder, constipation or diarrhoea, with rigors and fever, the 
yellowness of the skin increasing and heavily tinging the white 
of the eye, with dullness, stupor, coma, and itching of the skin. 

Although this simple form is not regarded as serious, still 
grave doubts may be entertained regarding it if the fever is 
high and jaundice heavy. So by all means let the treatment 
be active : an emetic of equal parts of composition powder and 
pulverized lobelia, preceded by copious alkaline drinks, best 
given in small doses, say every five minutes, until free emesis 
takes place, then an alcoholic vapor bath, followed by an active 
purgative acting chiefly upon the liver, such as mandrake and 
cream of tartar, or, if the patient is feeble, phosphate of soda 
or white liquid physic. This acts well as an aperient. It is 
mild in its action, rarely disagrees, brings away an immense 
quantity of bile, such as we are unable to obtain by any other 
cathartic. The patient kept in bed, fever controlled by aconite, 
veratrum, gelsemium (green root tincture), and sweet spirits of 
nitre, one teaspoonful of each to half a tumbler of water, of 
which one teaspoonful should be given every hour till febrile 
symptoms abate. Over the liver and stomach, hot packs of water 



FEVER. 86 

highly acidulated with nitro-muriatic acid, renewing frequently. 
The daily sponging of the entire body with an alkaline wash 
must not be omitted. Diet, milk and lime-water, arrow-root, 
and other farinaceous articles. 

Then the principles of treatment are to stimulate the liver 
with nitro-muriatic acid, five drops thrice daily, in water, or 
an infusion of the fringe tree or wahoo, or leptandra, or kur- 
chicine ; keeping the bowels open twice a day with phosphate 
of soda or cream of tartar, in the form of a lemonade ; estab- 
lishing convalescence upon tonics and generous diet. 

INTERMITTENT OR MALARIAL FEVER, OR AGUE. 

Characterized by febrile paroxysms, which come on at a defi- 
nite or specific time, ushered in by a rigor, followed by a fever, 
ending in a critical sweat, and during the intermission or 
remission there is an interval of apparent good health, but at 
the end of a definite interval the phenomena are repeated, and 
this occurs again and again until a cure is effected. 

Cause. — The spore or germ of decaying vegetable matter, 
acted on by solar heat exceeding 75° or 80° Fah., becomes 
active. The germs may come from a marsh, or soil, or stag- 
nant pool, or the surface of the ground, or impregnate the 
water drank. 

Whether the germ enters the body and is capable of growth 
and production therein (sprouting, growing, and seeding), and 
causing grave changes in the blood and vital organs, or whether 
the germ or poison in a special and peculiar manner changes 
or degrades normal living matter into a diseased malarial 
germ, it is impossible to say. It is not regarded as contagious 
or infectious, like its twin sister, yellow or relapsing fever, 
although this is doubtful. No germs but bacteria and a much 
diffused spore have been detected in the blood with the micro- 
scope, still there is a body which when taken into our 
bodies and those of animals is capable of producing grave 
pathological changes and even death. What it is we cannot 
tell ; all we can say is, vegetable decomposition is the source 
of the poison. From these organic elements are evolved spores 
which are ponderable, because those who sleep on the ground 
or lower rooms of dwellings are more readily affected. Fires 
destroy them, hence large cities, as a rule, are exempt from the 
presence of the poison. Certain trees that possess in their 
roots, bark, leaves, flowers, medical properties capable of anni- 
hilating the germ in the human body, have also the faculty 
while in a state of growth of attracting and appropriating 
the poisonous or diseased germ elements to their own use or 
nutrition — all the malarial germs in their immediate vicinity. 
When planted in a deadly malarial swamp they attain an 



84 FEVEE. 

immense growth and free the locality from the least vestige of 
the poison ; such trees as the eucalyptus, magnolia, willow, &c." 

The search for the malarial germ, the contagium vivum of 
malarial poisoning, has engaged the attention of the entire 
medical profession and appears to be successful. The seeding or 
cropping of the germ during the attack is a settled fact, as it has 
been seen in the blood of patients suffering from the disease. 
Besides the ordinary bacteria so numerous in this fever, there 
are special micro-organisms variable in number according 
to the type of fever, that bury themselves in the red cor^ 
puscles of the blood, and on the beginning of an attack the 
spores grow and sprout with great vigor. They are invari- 
ably present in the blood of malarial patients. The red cor- 
puscle is the habitat of the germ. Here it develops and can be 
seen as a round spot on the corpuscle, which it pierces. The 
rate of growth is immense — millions in an hour. The dull, 
drowsy, comatose state is due to the breeding of those parasites 
in the cerebral capillaries ; they perfectly demoralize the red 
globules, and they are so numerous that a total obstruction of 
the circulation often takes place ; they destroy the red discs, 
which explains the remarkable anaemia often present. 

The characteristic of this form is its periodicity — its parox- 
ysms occurring at longer or shorter intervals, but with definite 
precision, most frequently recurring every twenty-four, forty- 
eight, or seventy -two hours. When the paroxysms occur at the 
same hour every day, the fever is called quotidian ; when every 
other dav, tertian ; and when absent for two whole days and 
then recurs, quartan. In the quotidian the interval is twenty- 
four hours ; in the tertian, forty-eight hours ; and in the quartan, 
seventy -two hours. The period between the termination of one 
paroxysm and the commencement of the next is the intermis- 
sion. In the quotidian form the paroxyms occur for the most 
part in the morning; in the tertian, at noon ; in the quartan, in 
the afternoon. Besides these forms, we meet with cases occur- 
ring once a week, once a month, once a year. Any type may 
be double, that is, occurring twice during its specified time. 

Symptoms. — This fever may set in suddenly, or it may 
come on gradually with a feeling of general indisposition, 
which at the end of a few days may culminate in a regular 
paroxysm. An ague fit is composed of three stages, the cold, 
hot, and sweating. The cold stage is ushered in with feelings 
of languor, lassitude, debility, headache, pain in the back and 
limbs, chilliness. There are sensations as of cold water run- 
ning down the back ; shivering; the skin is shriveled and the pa- 
pillae rendered prominent, the skin assuming the appearance of 
a plucked goose (cutis anserina), resulting from irritation of the 
nerves that supply the microscopical muscles of that gland, 



FEVER. 85 

which are called arredores pilorum. The teeth chatter, the nails 
turn blue, and the whole body is shaken ; there is exhaustion, 
often urgent thirst; the countenance is anxious; the features 
contracted; eyes dull and sunken; pulse feeble; respiration 
hurried or oppressed ; mental irritability. The duration of this 
stage varies from a few minutes to several hours, and is suc- 
ceeded by the hot or febrile stage. 

Then all the symptoms of fever are well defined : increased 
respiration ; more frequent pulse ; elevated temperature ; 
parched mouth ; excessive thirst ; painful sense of fullness in 
the head ; great restlessness ; irritability ; delirium. 

This stage may last a short time or for some hours. Then 
follows the sweating stage, beginning with a slight moisture on 
the forehead, then over the entire body. After its decline, 
all the symptoms become ameliorated, and the patient to all in- 
tents and purposes seems to be in perfect health until another 
paroxysm takes place. 

Sometimes one or two of the three stages are absent. 

Malarial germs are taken into the human body by the skin, 
bronchial mucous membrane, but especially by the salivary 
glands of the mouth, swallowed, and thence taken up into the 
circulation. Food and water may also supply them. When 
they get into the circulation they produce the following toxical 
results : 

1. More or less irritation of the brain, according to the 
amount of germs present and power of vital resistance. 

2. A blood-disease is engendered — that fluid is loaded with 
bacteria and malarial germs, and as they increase in number 
it becomes fibrinous or clotty, and dark colored. Such blood 
coagulates readily in the fine, delicate interstitial structure of 
the brain, in the granulated structure of the liver and kidneys, 
in the very vascular structure of the spleen, and even adheres 
in masses to the walls of arteries. When this condition has 
lasted months or years, a white-cell condition or leucocythemia 
is brought about. 

3. This white-cell disease of the blood is properly the third 
stage, and is brought about by the malarial germ using up in 
its own nutrition the elements of the red corpuscles, aided by 
the morbid condition of an enlarged, indurated, or caked, or 
hypertrophied state of the spleen or an amyloid degeneration of 
other glands. This fever is easity recognized by the paroxysms 
occurring with periodicity, being ushered in with rigors, fol- 
lowed with fever and a sweat. During the remissions an inter- 
val of apparent good health, but at the end of a certain interval 
the phenomena are repeated. 

The Morbid Conditions are irritation of brain, liver, 
kidneys, spleen, with blood loaded with living disease-germs. 



6b FEVER. 

In all forms of shock there is a determination of the capillary 
circulation to the internal viscera; the spleen, the safety-valve of 
the heart, suffers most, as the blood is driven inward. True, the 
congestion subsides during the intermission, but repeated 
attacks with the peculiar bacterial blood give rise to hyper- 
trophy and induration. 

Treatment. — In the general management of this fever, the 
patient should be well nourished with good food ; clothing 
warm, and rest in the recumbent posture inculcated. During 
the cold stage the patient should be carefully nursed, the feet 
immersed in hot mustard and water, and warm drinks of an 
infusion of boneset, or capsicum, or composition should be 
taken freely, and external warmth by hot bricks and bottles of 
hot water wrapped in flannel applied all round the body, and 
well covered with blankets. 

As soon as the fever appears they can be removed, and cool- 
ing drinks administered, the body sponged with tepid water, 
and two drops of tincture of aconite and veratrum given every 
hour as long as the fever lasts. When the hot stage subsides 
into the sweating, the action of the skin should be slightly 
stimulated by allowing the patient to drink freely of an infu- 
sion of boneset. During the interval the attack of fever must 
if possible be broken up. For this purpose an emetic of equal 
parts of lobelia and composition should be administered, pre- 
ceded by copious drinks of tepid water and bicarbonate of 
soda. One teaspoonful of the pulverized gum lobelia and the 
same amount of composition to half a pint of tepid water — a 
wineglassful every five minutes. Lobelia has a retrograding 
action on disease-germs, and reduces their activity. This should 
be followed by an alcoholic vapor bath, after which, if the inter- 
mission permits, an active cathartic of white liquid physics. 
At this point there must be made a selection from two classes 
of remedies, one that acts chiefly on the nervous system, in 
producing a quasi suspension of its vital activity, which class 
is represented by quinine, green root tincture of gelseminum, 
salicin, &c; the other, which acts directly on the germ in causing 
its destruction in the blood, such as tincture of iodine, euca- 
lyptus. 

If we make our selection from the first class, our most im- 
portant remedy is quinine. It probably acts on the malarial 
germ by diminishing oxidation, impairing the oxygen-carry- 
ing powers of the red blood-globules and suspending vital 
activity. For the purpose of being at once effectual, it is use- 
less to give it in small doses at long intervals. One large dose 
should be given at once, or if in divided doses, at short inter- 
vals. The sulphate dissolved with a few drops of aromatic 
sulphuric acid forms abisulphate, so that five grains are equal 



FEVER. 87 

to ten when so dissolved. Now it is impossible for us to say 
the special dose, whether it be ten or twenty grains ; if a bad 
case let it be large, dissolved in water and followed in fifteen 
minutes with half a teaspoonful of green root tincture of gel- 
seminum. In half an hour, if thought best, they both could be 
repeated If the chill and fever are aborted the first time, 
which is likely, the remedies should be given at the same time 
each day, in smaller doses, for several successive intermissions, 
so as to be certain of the result. 

Of the different preparations of salicin, salicylate soda, given 
in large doses, has a powerful effect and acts rapidly, but is 
very apt to cause prostration or failure of the circulation. The 
second class of remedies are those that destroy the malarial 
germ in the blood, such as tincture of iodine, eucalyptus, &c, 
and must be administered right along. The tincture of iodine, 
from ten to twelve drops in half a glass of sweetened water 
or sweet milk, every four hours, is equal to quinine. Indeed, 
the results are highly satisfactor} r , so much so that it may be 
regarded the best remedy ; at any rate it is an excellent substi- 
tute, acts in some cases almost as by magic. In many instances 
the paroxysms are not repeated after the medicine has been 
given two or three days. 

The fluid extract of eucalyptus prepared by compression, 
given in teaspoonful doses every four hours, or the oil in ten 
to twenty drop doses, dropped on sugar, will succeed in some 
very mild cases. 

In cures effected with the quinine and gelseminum, or the tinc- 
ture of iodine, the patient should be kept upon a good tonic 
for several weeks subsequent to recovery. 

In order to show the utility of remedies in the cure of this 
sometimes stubborn affection, we append a few formulae that 
are sometimes used in chronic cases : 

Take of sulphate of quinine, twenty grains ; prussiate of iron, 
twelve grains; solid extract of gelseminum, one grain; solid ex- 
tract of mandrake, three grains ; capsicum, twenty -five grains. 
Mix. 

Make six powders, and give at suitable intervals so that the 
patient takes three before the chill. The same prescription 
can be made into pills by adding twelve drops of the oil of black 
pepper, making it into twenty pills ; the patient taking six at 
proper intervals before the chill. 

The following operates well: 

Glycerine, four ounces; tincture of iodine, half an ounce; 
oil of eucalyptus, half an ounce. Mix. 

A teaspoonful every four hours in sweetened water. 

The following answers well : 

Port wine, one pint ; sulphate of quinine, one drachm ; aro- 



88 FEVER. 

matic sulphuric acid, half an ounce; pulverized cinchona, one 
ounce; capsicum and cloves, of each, a tablespoonful. Mix. 

One to two tablespoonfuls every three hours. In preparing 
the above, dissolve the quinine separately with the aromatic 
sulphuric acid, then add to the wine. It is unnecessary to 
shake up when used. 

We have found the following often succeed : 

One ounce each of pulverized cinchona, cream of tartar, and 
cloves. One teaspoonful every two hours. 

There are a very large list of remedies in use, most of them 
quite worthless, as sulphate of bebeerine, chinodia, quinquina, 
dextro-quinine, bisulphate of quinine pills, which, if gelatine- 
coated, are very reliable; salicine, cornia, boneset are worth- 
less. 

A hypodermic injection of one or two grains of sulphate of 
quinine in solution half an hour before the chill, is very effica- 
cious in its arrest. 

After the breaking of the chill, the patient to be placed upon 
teaspoonful doses of Huxham's tincture of bark for a few weeks. 

The above treatment is usually sufficient for the first stage ; 
in the second, where the blood is heavily loaded with bacteria 
and malarial germs, there must be antiseptics administered in 
addition, and those of an alkaline character should have the 
preference, because they act best on the liver. Chlorate potas- 
sium in five-grain doses, thrice daily; or permanganate potas- 
sium, half-grain doses; or muriate or sesquicarbonate of am- 
monia, sulphite of soda, phosphate of soda, either in five-grain 
doses. One of the above selected and given at regular intervals 
in water. They are nearly all of equal value. The treatment 
in the first stage must, in addition, be carried out. 

In the third stage, where we have the red discs greatly de- 
ficient and the white corpuscles in excess (see Leucocythemia), 
the blood thoroughly disorganized by the destructive action of 
the two germs, malaria and bacteria, years will be necessary 
for a cure, during which time alteratives and tonics, generous 
diet, country air, flannel clothing, and all known means of pro- 
moting a high standard of health should be resorted to. 

It requires great perseverance on both the part of the patient 
and physician, but hold on, do not deviate, stick firmly to al- 
teratives and tonics with best of diet and regular bathing, and 
a cure will generally be effected, unless the spleen is irretriev- 
ably softened. 

REMITTENT FEVER. 

This fever bears a strong resemblance to intermittent in its 
cause, but is more serious in its effects. It occurs in the form of 
a continued fever, characterized by remissions. There is no 



FEVER. 89 

cessation of the fever, simply an abatement or diminution. 
The period of remission varies from twelve to twenty-four hours, 
at the end of which time the feverish excitement increases, the 
exacerbation being often preceded by a chill. 

The cause is the malarial spore or germ acting upon vital 
forces already exhausted. 

Remittent fever varies much in severity, according to the vital 
forces or peculiarities of the individual affected; the locality 
has less to do with the peculiarity or type than the individual, 
for the germ or contagion is the same, hence the idea of de- 
scribing it under the names of localities is absurd. But if we 
have a germ from a river-bed (paludal), as well as a malarial, 
present, it is very apt to take on a strong bilious or even a 
malignant type. 

Symptoms. — Usually commences with languor, lassitude, 
debility, mental depression, headache, shivering followed by 
high fever, vomiting, sometimes jaundice, often accompanied 
with delirium ; pulse frequent and full ; tongue dry and furred ; 
nausea, vomiting, generally of bilious matter ; sense of pain at 
the epigastrium, and tenderness on pressure, with signs of pul- 
monary congestion, great difficulty of breathing, a feeling of 
oppression at the chest, cough, and a livid color of the counte- 
nance. The urine is usually scanty, high-colored, and loaded 
with lithates, but passed in increased quantities during the re- 
mission. Length of remission varies from six to twelve hours 
and from twelve to twenty-four hours ; at the end of which 
time the feverish excitement increases and the exacerbation is 
usually preceded by chilliness and a rigor. Remission usually 
occurs in the morning ; the principal exacerbation is generally 
towards the evening. The disease may run on for some fourteen 
or fifteen days and end in. an attack of sweating, or merge into 
typhoid or cerebro-spinal meningitis. The period of convales- 
cence is usually short, except some organic mischief has occurred, 
in which case considerable time may elapse before a restoration 
to health is effected, the debility being kept up by night-sweats, 
sleeplessness, dyspepsia, neuralgia, jaundice, and dropsy. 

Complications. — The extreme severity of some cases, the 
depressed condition of the nervous and vascular systems, with 
defective secretions, the great exhaustion at the termination of 
a paroxysm, collapse, convulsions, or delirium, passing into 
drowsiness and coma, cerebro-spinal irritation, with gastric irri- 
tability, or with bronchitis, pneumonia, or with hepatitis, jaun- 
dice, diarrhoea, or typhoid symptoms. The chief causes of the 
complications are great depression of vital power, with epidemic 
influence and improper treatment. 

As a rule the fever terminates in recovery in two weeks or 
some of its numerous complications. 



90 FEVER. 

The diagnosis is important : a continued fever with remissions, 
when complications arise, other morbid states taking place, the 
points of recognition may be varied. 

Treatment. — Begin with an emetic of equal parts of green 
lobelia and boneset in infusion, preceded with copious drinks 
of tepid water and bicarbonate of potash; thorough emesis; 
subsequently an alcoholic vapor bath; then unlock the bowels 
with an anti-bilious physic; then rest in bed, and the general 
treatment for fever. It must be borne in mind that the febrile 
exacerbation is of longer duration and of greater intensity than 
in intermittent, so there is more danger of structural lesion of 
brain, liver, spleen, stomach, and kidneys, and our first great 
object should be to effectually equalize the circulation and mod- 
erate the excitement with a mixture composed of four ounces 
of water to which is added one teaspoonful of tinctures of vera- 
trum viride, aconite, green root tincture of gelseminum, and 
sweet spirits of nitre, one teaspoonful every half-hour until 
all febrile excitement has become ameliorated and the pulse 
down to seventy. Then begin with remedies to destroy the 
germ. For this purpose it is best to resort to a combined treat- 
ment of the two classes of remedies, so as to break it up. So that 
it is well to give quinine, either with prussiate of iron, or in the 
form of a bisulphate, that is, dissolving it with aromatic sul- 
phuric acid in from one grain to several, every four hours, and 
alternately to give the tincture of iodine in ten-drop doses be- 
tween, in sweetened water, holding the heat, respirations, and 
pulse in absolute control by the veratrum and gelsemium. 
Keeping the liver well stimulated with phosphate of soda, or 
white liquid physic. If there be diarrhoea and restlessness, then 
teaspoonful-doses of the following could be used : 

Compound syrup of rhubard and potassium, four ounces; 
bromide of potassium, half an ounce; bromide of ammonia, a 
quarter of an ounce; chloral hydrate, half an ounce. Mix. 

The diet should consist of milk and lime-water, beef tea, or 
farinaceous food. Complications looked for and carefully guarded. 
If there seems to be much cerebral disturbance, active purga- 
tion, mustard to feet, head shaved, and evaporating lotions of 
camphor-water and ammonia applied. If there is low delirium 
or exhaustion, or cerebro-spinal irritation, dry cups followed 
by mustard poultices to nape of neck. 

In our Southern States, both intermittent and remittent fever 
are often complicated with hematuria, or a hemorrhage of 
blood from the kidneys, to arrest which the treatment laid 
down must be adhered to, the dose of the gelsemium increased, 
and dry heat by means of hops, or chamomile flowers baked in 
an oven and applied in small bags over the region of the kid- 
neys. General treatment for fever carried out. 



FEVER, 91 

The Bilious Type of intermittent and remittent requires 
very nearly the same treatment. In these the force of the ma- 
larial and bacterial germs seems to be spent upon the liver, so 
that in those cases the tongue is heavily coated brown, there is 
nausea, vomiting, jaundice, diarrhoea, and other bilious symp- 
toms, — a state that will require special attention in addition to 
the treatment being carried out for the fever, such as the fol- 
lowing : five drops of nitro-muriatic acid every four hours in 
water, or an infusion of leptandra, drunk freely, or phosphate 
of soda. 

Some remedy to act efficiently upon the germs that block up 
the liver, managing the fever in the manner already indicated. 

REMITTENT BILIOUS FEVER, MALIGNANT. 

In terribly shattered individuals, the simple form is prone to 
assume this type. The heat here is high, the pulse very fre- 
quent, indeed, all febrile symptons reach their greatest inten- 
sity, the skin is jaundiced, the stomach irritable, the tongue is 
not only heavily coated with a brown coat, but it is black or 
dark-colored at the root, the brain poisoned, all the symptoms 
indicate extreme prostration from the action of the poison, with 
blood-poisoning. 

Treatment the same as in remittent, but more energetic 
remedies in larger doses and antiseptics must be freely admin- 
istered. One tablespoonml of brewers' yeast twice daily in sweet 
milk, or from five to ten grains of sulphite of soda, thrice 
daily, or sulphurous acid in water. Some one selected capable 
of destroying the germ, the factor of the fever, one capable of 
arresting molecular change, or the tendency to putrescency or 
corpuscular death is great. 

Bilious and malignant remittent fever requires in all cases 
the greatest tact and skill; nothing should be omitted. If the 
veratrum and aconite are not sufficient to equalize the circula- 
tion, larger doses of the green root tincture of gelsemium should 
be given every half-hour until the circulation is controlled, 
keeping up the quinine and prussiate of iron in alternation with 
the iodine. The dose of drugs must be increased to meet the 
condition of vital depression and malignancy of the attack, and 
on no account are antiseptics and stimulants to be spared, for 
Ave must ever bear in mind that the factors of the fever are the 
germs. 

RELAPSING FEVER. 

Relapsing fever, or recurrent fever, or malignant remittent 
fever, highly contagious and infectious. There is a febrile ex- 
citement all the time, but the remission and relapse takes 
place every five or seven days, when there is an immense 



92 FEVER. 

aggravation of all the symptoms. Epidemics have appeared at 
different times in the world's history, chiefly during seasons of 
famine and destitution, which has led authors to describe this 
fever under various names. 

The cause is the malarial germ, whose presence in the body is 
probably intensified by animal miasma. 

Symptoms. — There is generally a latent period of three or 
four days, during which the patient suffers from prostration, 
headache, languor, lassitude, debility, followed by rigors and a 
high grade of fever. The frontal headache and muscular pains, 
with pains in the back and bones, are so excruciating as to 
cause great restlessness and irritability. Temperature often 
107° Fah., with a pulse over 160, urgent thirst, often nausea, 
vomiting, pain in the stomach, jaundice often present. A very 
great aggravation of symptoms at night, giving rise to much 
irritability and sleeplessness. As the disorder advances there is 
constipation, scanty, high-colored urine and increasing pros- 
tration ; but just as the fever seems to be assuming a threaten- 
ing aspect, about the fourth or fifth day, a profuse perspiration 
breaks out over the whole body, a complete subsidence of fever 
takes place, the patient appearing quite well, but weak or suf- 
fering from rheumatic pains. The patient, and often inexpe- 
rienced physicians, imagine the trouble is over, when all of a 
sudden, about the fifth or seventh day, there is a relapse, a 
repetition of all the symptoms in an aggravated form. Graver, 
more alarming, week by week this goes on, each attack leaving 
the patient weaker and weaker, till on the sixth or seventh 
week he either succumbs to the poison or the case terminates 
in recovery. Troublesome complications often arise which delay 
recovery, such as petechia and purpuric spots, muscular weak- 
ness, oedema of the legs and feet, prostration. When it occurs 
in pregnant women, it has a greater tendency than any other 
disorder to cause premature labor. It is a very fatal form of 
fever, death taking place at any period from sudden prostra- 
tion. No special lesion can be detected upon making a post- 
mortem examination. The liver seems to suffer most from 
enlargement and congestion ; in other cases the spleen is 
found considerably increased in size. 

The treatment is in all respects similar to that laid down for 
typhoid. 

TYPHOID FEVER. 

Is essentially a contagious and infectious fever, capable of 
spontaneous development when the living matter of the nerv- 
ous system is degraded. In the blood, the blighting of nerve 
nutritive matter can be detected to some extent in any nervous 
shock, but it is immense in depression of the great sympa- 



FEVER. 93 

thetic and ganglionic nervous system. Indeed, typhoid fever 
may be regarded as the climax of all nervous depression, ca- 
pable of spontaneous germination within the body by great 
nervous depression, or disease, or by the intense struggle for 
existence incidental to civilized life. 

Wherever the nervous system is developed at the expense of 
the physical, there is a predisposition to this form of fever. 

It is caused by a degradation of the bioplasm concerned in 
nervous nutrition, and any condition of nervous depression 
may cause the change from normal nerve bioplasm into a 
disease-germ vibrios, and when once engendered the contagion 
is so active, or powerful, that it may be communicated by close 
contact in cars, through the air, water and food, by sewer gas, 
or effluvia from drains and cesspools, by sewage in rivers con- 
taining typhoid stools. Milk, or raw or even cooked flesh of 
animals or fowls coming in contact with the vibrios in the air 
may communicate the disease. Contamination of drinking 
water by sewers is one of our chief vehicles of propagation. 
For when the vibrios enters the sewer, and then the lake or 
river, the germs become very active, and acquire a power or 
potency incomprehensible. 

It is true the predisposing cause is nervous prostration, which 
in itself may be sufficient to cause the necessary degradation of 
bioplasm, the vibrios; among the most prominent of those 
causes, mental strain or exhaustion, depressing climatic states, 
solar heat, chills, damp, overwork. In the large class of nerv- 
ous diseases, the vibrios are so prolific that they emanate from 
every part of the body, and are to be found in or on everything 
in close proximity to the affected person. 

Those mysterious languors, headaches, lassitudes, &c, un- 
classified, unnamed, and often unpitied, which distress patients 
and puzzle physicians, are simply the presence of this germ in 
the blood, for it can only find its abode in the weak, feeble, or 
shattered. 

Symptoms. — Usually a period of incubation or germ-growth 
varying from ten to fourteen or even twenty-one days, in which 
languor, lassitude, debility, insidiously make their appearance, 
with headache, white face, sharp features, pain in back and 
calves of the legs, nausea, diarrhoea, and chilliness. The rigors 
recur from time to time at uncertain intervals, with an aching- 
all over. The rigors increase, and the patient is much pros- 
trated. There may be vertigo, deafness, or epistaxis ; great 
headache; intolerance of light; thirst; loss of appetite; great 
nervous irritability; restlessness; nostrils pinched; often a 
marked, circumscribed flush on each cheek ; tongue at first 
white, with red edges and tip, later red and glazed, buff dry 
or brown; sordes on gums, pulse small, wiry, frecpient, 100 to 



04 FEVER. 

120 or higher; temperature from 101° to 104° Fah., higher in 
the evening; breath offensive and ammoniacal. These symp- 
toms slowly become aggravated ; emaciation is great from the 
destructive action of the germ and imperfect renewal of tissue ; 
continuous destruction — defective supply. The solid constitu- 
ents of the urine increase; the tendency to diarrhoea becomes 
greater ; great interstitial death ; rapid metamorphosis of the 
entire body. 

At the commencement of the second week, or a day or two 
earlier, the typhoid rash appears; rose-colored spots on the 
chest and abdomen, few in number, circular, disappearing on 
pressure, and fading away to be replaced by a fresh crop. In 
ten or twelve per cent, of cases, no rash. It is a true petechia. 
After the middle of the second week, tympanitis, gurgling in 
the right iliac fossa on pressure, diarrhoea, stools alkaline, of a 
pea-soup appearance. If there is extreme debility with profuse 
sweating there may be sudamina, or small watery blebs on 
neck, chest, or abdomen. There may be other symptoms 
present, as violent delirium, spasmodic contractions of the 
muscles, picking at the bedclothes, subsultus, hiccough, tinnitus 
aurium or deafness, muscular pains, prostration, bed-sores, and 
attacks of hemorrhage from the ulcerated patches in the ileum 
and perforation of the bowel, with fatal peritonitis, is to be 
found. Congestion of the kidney, cerebral or pulmonary com- 
plications ; the latter is the most common and most to be dreaded, 
and is easily recognized by the flush on right cheek ; cough, 
rusty sputa, dullness on percussion at the base of the right lung. 
During convalescence a venous murmur can be detected in the 
neck, and an inorganic systolic bruit in the heart, same as in 
anaemia, which quickly disappears on giving nourishment, 

Duration should be from two to three weeks ; still, some cases 
are prolonged to the fifth or sixth week. 

It may terminate in recovery, paralysis, or death. Death is 
usually due to exhaustion from the protracted fever, or from 
diarrhoea; sometimes to pulmonary and cerebral complications, 
or to perforation of the bowel and peritonitis, or to hemor- 
rhage; occasionally to uraemia. In some cases the patient 
seems to be overwhelmed by the poison-germ and dies easily 
with cerebral symptoms, delirium, and coma. When recovery 
takes place with paralysis, it is generally due to anaemia, which, 
in nearly all cases, can be overcome with good diet. 

A persistent rise in temperature over 105° Fah. is very un- 
favorable, and several degrees above, an almost fatal result. 

Typhoid fever is easily recognized by its insidious mode of 
attack, by the nervous prostration, b} T the ringing in the ears 
or deafness, bleeding at the nose, rapid emaciation, white, 
sharp-pointed features, sunken eyes, and pinched nostrils; dry, 



FEVER. 95 

buff-leather tongue, red tip or edges, or smooth and glassy; 
sordes on teeth and gums ; small, wiry, frequent pulse, irrita- 
tion, inflammation, and ulceration of the' glands of Brunner 
and Peyer of the small intestine; with tympanitis, gurgling 
in right iliac ; diarrhoea, petechia, sudamina. 

It bears no analogy or resemblance to typhus, — in no single 
point. Pathologists are agreed upon one point, that there is 
nothing in common. In typhus fever the poison or fever germ 
is bacteria; in typhoid, the disease-germ vibrios, — a specific 
disease-germ, a true contagium vivium, having properties as 
distinct and powers of reproduction as perfect as any germ or 
species known to botanists and zoologists. 

The appearances after death are most significant : the blood 
and all the tissues and glands are loaded with vibrios, con- 
gestion of the brain or its membranes, ulceration of oesopha- 
gus and stomach, enlarged or friable condition of the spleen. 
The two lesions that are invariably present are inflammation, 
and ulceration of the glands of Brunner and Peyer. The al- 
terations in the aguminated glands or Peyer's patches are the 
most marked in the group of glands which are nearest to the 
ileo-csecal valve and in the corresponding glands of the mesen- 
tery. Frequently the patches have undergone ulceration. If 
the case has terminated at an early stage through prostration, 
we may simply find congestion, or a swollen condition of the 
mucous membrane over the patch or gland. Death, as a gen- 
eral rule, occurs at a later period, toward the ninth, tenth, or 
eleventh day, or at the end of the third week, and then we find 
the true condition of ulceration, in ulcers or sloughs varying 
in size. These ulcers are often the cause of death, either by 
hemorrhage or perforation. Mesenteric glands in the neigh- 
borhood are generally enlarged and softened. The enlarge- 
ment of spleen and left kidney is decided. 

The following are good rules to observe or bear in mind 
after death: Peyer's patches and the solitary glands of the 
lower part of the small intestine are always affected in typhoid 
fever, and the solitary glands in the large intestine in about 
one-third of the cases; that ulceration is perfect on the seventh, 
eighth, or ninth day of fever; that cicatrization begins in from 
two to three weeks, but may be delayed indefinitely or pro- 
longed by disturbance, as movement and diarrhoea. 

To prevent typhoid, our population must guard against over- 
work, privation, sorrow, and maintain a high grade of vital 
force. All unsanitary conditions avoided, good drainage, the ex- 
creta in cesspools destroyed, and above all good water supplied, 
— no sewerage to enter drinking water, nor no cesspool deep 
in the earth nearer than a mile to a well, and care exercised 
during convalescence. The patient should not for three months 



96 FEVER. 

be permitted to go among his fellows, as he is liable to dissem- 
inate the disease. 

Treatment. — As the strain upon the mind in our country is 
incessant, — physical and mental overwork common, civiliza- 
tion of that kind that rapidly wears out the nervous system, 
the degradation of the living matter into the disease-germ vi- 
brios is very common, so much so that typhoid fever may 
justly be regarded as our national fever, the one truly indig- 
enous to our people. 

The very instant it is recognized, the affected individual 
should be placed in bed, and caused to maintain the recum- 
bent position. The apartment in which he is placed should be 
well ventilated, and, if possible, not connected with others; 
there ought to be an open fireplace, and if the weather permits 
a fire; there should be no bed or window-curtains, nor carpets, 
nor superfluous furniture in the sick-room; a disinfectant of 
some kind should be freely used and exposed in the apartment. 
Two beds are of great utility, so that the patient can be lifted 
from the one to the other, and the bedclothes, as well as the 
body-linen, changed daily, and strict quarantine maintained, 
few but the nurse and physician admitted. No food left un- 
covered. 

Suppose we see this case early and recognize it beyond the 
possibility of a doubt, either during the so-called stage of incu- 
bation or germination, or even as late as seventy-two hours 
after the rigor, an effort at breaking up the fever is worthy of 
a trial. It is often successful on the following plan: Dry cups 
applied on both sides of the spine and over the solar plexus in 
the abdomen ; follow with a gentle but stimulating emetic of 
lobelia and capsicum, preceded by copious drinks of tepid 
water and bicarbonate of potassa, — the emetic to be given in 
small doses untill free vomiting takes place ; follow with an 
enemata, and as soon as that has acted, an alcoholic vapor 
bath for twenty or thirty minutes; then the patient to be placed 
in bed, heat to feet, and the following ointment to be rubbed 
in over the discoloration produced by the cups : Vaseline, two 
ounces ; hydrate of chloral, a quarter of an ounce ; camphor, 
half an ounce ; and the tincture of the green root of gelsemium 
and sulphate of quinine administered internally. In the use 
of the two drugs there must be great discretion and boldness. 
What we want in as short a time as possible is the full physio- 
logical effect of both remedies. The advantages of the tincture 
of the green root of gelsemium are, it is safe, it exercises a pe- 
culiar retrograding action on germ matter, has a good effect 
on the vaso-motor system, stimulating the vagus, and thus 
slows the heart, at the same time dilating the capillaries. It 
should be given in half-teaspoonful doses, repeated every half 



FEVER. 97 

hour. The next remedy is quinine, which diminishes oxida- 
tion and aids in the elaboration of red corpuscles, at the same 
time producing a cerebral state called cinchonism, unfavorable 
for germ-growth. The quinine is so freely and rapidly elimi- 
nated by the kidneys that a grain or two of pulverized opium 
should be given with it, so as to prevent its escape. For our 
purpose the quinine must be given in large doses, or three 
smaller ones inside of half an hour, and not less than twenty, 
thirty, or forty grains in all ; the opium not to exceed one or 
two grains ; the gelsemium carried up to double vision and pro- 
found muscular relaxation. Sleep, narcotism, anaesthesia fol- 
low for ten or more hours, during which time the germ dies in 
the body, and the patient makes a speedy recovery. This 
principle of obtaining the death of a germinal poison is diffi- 
cult to explain, but practically it operates well in aborting 
the fever. It is a method with which I have had great success. 
After the third day I deem it of no utility, as grave changes 
take place rapidly. One thing is certain, that it can in no way 
interfere with the subsequent management of the fever. 

Suppose the fever progresses, or that we have seen it too late, 
then general principles of treatment should be carried out. 
Patient sponged three times daily with an alkaline wash, well 
dried, and rubbed with the dry hand of a young, vigorous 
nurse. After the mid-day sponging, warm vinegar and water 
should be used, as the acid excites the normal' alkaline secre- 
tion of the skin and destroys germs on its surface. After the 
evening bath, inunction of warmed olive oil into the entire 
body; it attracts and smothers germs, by endosmosis it pro- 
motes nutrition, and if performed by a young, healthy nurse, 
its reflex effect upon the nervous system is of a very vitalizing 
character. Heat to feet, and hot poultices of linseed meal and 
glycerine to the abdomen all through the fever. The dietetic 
management should be attended to with great care. Suppres- 
sion of the salivary and pancreatic secretions interferes w T ith 
the digestion and assimilation of starchy matters, and if given, 
become irritants to the intestinal tract, so that milk and lime- 
water, with beef tea, forms the best diet. Stools, when passed, 
should at once be disinfected by a solution of sulphate of iron. 

Febrile action should be controlled with two or three drop 
doses of tincture of aconite every hour or less frequent, and if 
necessary an occasional drop of veratrum viride. Small doses 
of quinine should be given all through the fever, one ounce of 
aromatic sulphuric acid to thirty grains of quinine. Mix. 
Fifteen to twenty drops three times a day. Diarrhoea in all 
cases to be controlled by half a grain of pulverized opium to 
one of tannic acid in a pill, or by boiling the milk used for 
food with cinnamon sticks, straining, and then adding lime- 



98 FEVER. 

water. Sleep is of great importance, as there is no nutrition 
without it, so if the patient does not sleep, anodynes must be 
given. A hop pillow might be tried. If that fails select one 
of the following : 

English extract of hyoscyamus, solid, twelve grains ; pulver- 
ized opium, two grains ; sugar of milk, thirty grains. Mix. 

Make twelve powders ; begin at 6 p. m., and give one every 
hour or two hours till sleep is procured. Repeat every night 
if they operate favorably. If they do not seem to answer well, 
then try 

Camphor water, two ounces; bromide of potash, half an 
ounce; chloral hydrate, sixty grains. Mix. 

Give a teaspoonful every two hours. If the above does not 
procure long, refreshing sleep, then use the following : 

Cinnamon water, four ounces; sulphate morphia, four grains ; 
bicarbonate potash, fifteen grains. Mix. 

One teaspoonful every hour. Thirst in typhoid is best 
allayed with a few drops of dilute phosphoric acid and water, 
or ozone water. If there is rapid emaciation there can be no 
doubt of the propriety of arresting the metamorphosis by the 
administration of alcohol, otherwise it is of no utility. 

Antiseptics or germicides are all-important in typhoid — pow- 
erful in the destruction of the germ. By the use of antiseptics, 
destroying the germ, we kill the main factor of the disease and 
give the vital forces a chance, a preponderance to the side of 
recovery. The great factor here is the germ. Kill it as fast as 
evolved, and thus obviate the injurious effects that are likely to 
arise from its action on the blood. Indeed, the intensity of 
symptoms is not only modified or ameliorated but abrogated 
by its destruction. The febrile action in typhoid is in direct 
proportion to germ-growth. Even in our dietetics we retain 
the idea, — destruction of a germ : to the beef tea we add a few 
drops of hydrochloric acid, and to every tumbler of milk a tea- 
spoonful of lime-water, which not only prevents the casein of 
the milk from coagulating, but is a germicide in itself. But we 
select a few out of the number ; one must be given regularly to 
the patient at least twice or three times a day. 

Brewer's yeast, one tablespoonful thrice daily, in half a tum- 
bler of sweet milk. 

Glycerite of ozone, that great scavenger of diseased blood, 
thirty drops in water thrice daily. 

An infusion of baptisia tincture drank freely. 

Chlorate of potassium and dilute muriatic acid, five grains of 
the former to four drops of the latter to half a tumbler of water, 
sweetened with sugar so as to evolve the chlorine. 

Tincture of iodine and carbolic acid ; one drachm of the car- 
bolic acid to one of tincture of iodine, added to fifteen ounces 



fever. yy 

of distilled water, in which oil of lemons and a little muriatic 
acid has been dissolved. The addition of the acid and oil 
of lemons disguises the smell and taste, and obviates any gas- 
tric or sensorial disturbance. A tablespoonful should be given 
every hour until heat, pulse, and respirations are normal ; then 
three time sa day, and continue for three or four weeks after 
recovery. 

The old formula of fifteen drops of spirits of turpentine in 
mucilage of acacia, with a few drops of oil of peppermint three 
times a day on the ninth, tenth, and eleventh days should not 
be discarded, as it is highly antiseptic, a powerful ozone gene- 
rator, and stimulating to the glands of the bowels. Sulphurous 
acid, a little added to water for a drink is excellent. 

The carbolic acid and tincture of iodine every hour, with the 
glycerite of ozone three times daily, seem to be the speediest 
remedies in destroying the germs and thus breaking up the 
fever ; besides their potent antiseptic properties, the latter is a 
nerve and brain tonic of unrivalled power. 

Every point must be carefully guarded; for prostration, mut- 
tering delirium, and irregular pulse, brandy should be given. 

Antiseptics act best on the ulcerated glands of the bowels. 
At least three times a day the mouth should be washed out 
with a little wine and water. The bladder must be seen to, 
lest any suppression of urine take place. Complications should 
be watched and met vigorously. Guard carefully against pneu- 
monia, which is the common sequel. 

Great care should be taken during the period of convales- 
cence, lest the cicatrizing ulcers be irritated; tonics, and a re- 
turn to general diet to be very gradual. No solid food allowed 
until all symptoms have disappeared. A tonic course of treat- 
ment, aromatic sulphuric acid and quinine, port wine and Pe- 
ruvian bark, or glycerite of kephaline administered for some 
months, and the recumbent posture rigidly maintained. 

TYPHUS FEVER. 

This fever has a spontaneous origin in the damaged bioplasm 
of our own bodies, the result of crowding large bodies of human 
beings together; hence it is described as putrid fever, jail fever, 
plague, pestilence, malignant, ship, or hospital fever. It may 
be defined as a contagious and infectious fever; often prevail- 
ing epidemically. 

So far, in the United States, we have been able to evade the 
generation of this type of fever ; but if the tenement system is 
carried out we may look for its appearance. When large bodies 
of children are congregated in schools purulent ophthalmia is 
often present, which is due to the same poison as typhus. 

The cause of typhus is the degraded bioplasm or living matter 



100 FEVER. 

of our own bodies, or that of other human beings into the living 
germ bacteria, which degradation is caused by over-crowding, 
ill-ventilation, &c. 

The usual symptoms are a period of incubation or shock, or 
sprouting of the germ in the blood from a few days to ten or 
twelve, during which time there is often bleeding from the 
nose or deafness, with great languor, lassitude, debility, head- 
ache, pain in the back or limbs. Then rigors, headache more 
intense, dry, heated skin, flushed face, suffused eyes, dull, 
heavy aspect, stupor, thirst, constipation, and prostration. 

Towards evening, irritability and restlessness, with sleepless 
nights. A measly-looking rash makes its appearance about 
the fifth day, consisting of irregular spots of a dusky or mul- 
berry hue, at first disappearing on pressure, later forming 
stains which are not obliterated on pressure, generally very co- 
pious; seen best on abdomen, chest and back, but especially 
over the breasts ; spots are often seen on back of wrists. When 
the rash is very dark colored, the blood has become the prey 
of the typhus germ, and is disorganized by the abstraction of 
its oxygen. Skin generally dusky, and besides the rash, often 
subcuticular mottling rash often remains permanent to the end 
of the fever, and may be accompanied by or become converted 
into petechia, sometimes mild, in other cases altogether absent. 

During the first week, bleeding at the nose, or deafness, or 
noises in the ears, conjunctiva injected, often constipation, never 
diarrhoea. Pulse from 80 to 100 to 160. Temperature 100° to 
105° Fah., steady, not variable like typhoid, tongue coated, 
brown and dry; dullness or stupor, looks like sleep but not re- 
freshing. Urine very scanty in quantity, retention common ; 
often albuminuria; occasionally total suppression of urine and 
uraemia. 

In the second week, great prostration, muscular twitchings, 
delirium, coma, and convulsions. The danger is greatly in- 
creased by an attack or supervention of acute bronchitis, pleu- 
risy, and pneumonia. Often a critical sleep, or sweat, or an 
attack of diarrhoea, or greatly increased flow of urine. Convales- 
cence is very rapid when it takes place, beginning generally 
on the fourteenth day. The fatal period is from the ninth to 
the twelfth day. 

Duration is from fourteen to twenty-one days. 

This fever is easily recognized by its history: the bleeding 
from the nose and deafness, the stupor or dullness, constipation, 
dry brown tongue, congestion of eyes and face, measly erup- 
tion when present. The blood is loaded with bacteria, thick, 
black, and clotty, and when thoroughly disintegrated becomes 
fluid, and is effused into brain, heart, lungs ; besides, the liver 
and spleen are alive with bacteria. 



FEVER. 101 

In order to prevent this fever, the people should be supplied 
with wholesome food and properly ventilated dwellings ; over- 
crowding in ships, sleeping- rooms, lodging or tenement houses 
prevented; smaller school-houses, and fewer children congre- 
gated together. All houses, or ships, ora lmshouses, to be kept 
thoroughly cleansed and whitewashed every three months. The 
clothes and bedding of any one tainted or affected should be 
disinfected. The patient kept scrupulously clean ; if just con- 
valescing he should not enter a street car or public conveyance. 
No room, or house, or public place in which an affected person 
has been, should be reinhabited or occupied until purified with 
chlorine gas or whitewash, and its walls and floors thoroughly 
deodorized. 

Treatment. — The patient should be kept in bed in a well- 
ventilated room, free from carpets and curtains' — disinfectants 
used freely; two beds if possible, that he may be changed daill ; 
if the weather permits an open fire should be kept in the apart- 
ment. 

The strictest quarantine to be maintained, none but the nurse 
and physician permitted in the apartment. An emetic of lobe- 
lia, an alcoholic vapor bath, and bowels opened with an anti- 
bilious physic. Then arterial sedatives, aconite, veratrum, gel- 
semium, administered. Sponging the body three timesa day 
with vinegar and water is not only grateful to the patient but 
highly destructive to the germs of disease. 

The primary action of the bacteria is on the red corpuscles 
of the blood; they abstract oxygen from that fluid and unfit it 
to stimulate the nervous centres, and the result is the serious 
and nervous symptoms which are observable in bad typhus. 
One great object in treatment is to supply the blood, the ele- 
ment which nature demands, and aid its transmission to the 
tissues and at the same time destroy the disease-germ with an- 
tiseptics. The latter should be commenced early. Among the 
best are ozone water, chlorate or permanganate of potassium, 
sulphite of soda, yeast, tincture of iodine, and carbolic acid. 
Select one and give persistently until there is a manifest dimin- 
ution of temperature. The utmost benefit is to be derived from 
this class of remedies. 

The sulphate of quinine and tincture of iodine to be admin- 
istered the same as in remittent fever. If there is coma or sleep- 
lessness, shave the head and apply cloths wrung out of warm 
water in which sesquicarbonate of ammonia has been dissolved, 
and give bromide of potassium with chloral as in remittent. 

If vital force is low, dark and abundant rash, suffused eyes, 
wakefulness, delirium, picking at the bedclothes, with signs of 
collapse, give stimulants, wine and quinine, strong beef tea, 
or chicken broth ; the administration of stimulants every hour, 



102 FEVER. 

and nourishment persistent and often. For urine retained, use 
the catheter. If diarrhoea occurs, it is usually salutary. Liquid 
nourishment, beef tea and milk, and all through the case 
either brewers' yeast or permanganate of potassium, thrice daily. 

General principles are to be followed in all cases. 

During convalescence mineral acids and cinchona, a gradual 
return to solid food, and country air. 

THE PLAGUE. 

Black death or glandular pestilence is simply the bacteria of 
typhus operating upon one whose vital forces are a perfect 
wreck. It has all the characteristics of typhus, and in addition 
the rash is in dots, purple-colored, and there is inflammation 
and suppuration of the lymphatic glands. It is extremely 
contagious, comes on with great violence, runs its course rap- 
idly; petechia? come out early, glands of neck, axilla, groin, 
and mesentery inflame and suppurate. Boils, fever, diarrhoea, 
vomiting, hemorrhages, convulsions, prostration, congestion, 
and softening of heart, liver, spleen, and kidneys. 

Treatment the some as typhus; push antiseptics, and in order 
to prevent the bacteria from contaminating all around keep 
the body well covered with oil so as to smother them when 
they seek the skin. 

YELLOW FEVER. 

Bilious remittent yellow T fever, accompanied with acute in- 
flammation of the stomach, liver, spleen, kidneys, with severe 
headache, vomiting of black matter, and jaundice, is a fever 
caused by the malarial germ, and one produced by miasma of 
river-beds, a dual poison or fungus. Limited to tropical coun- 
tries, not of infrequent occurrence in our Southern ports. The 
poison or fungus may be conveyed to temperate latitudes on 
clothing, r ils, planks, vessels, merchandise, but the germ is 
there incapable of growth. It may occur in tropical parts, 
endemically, epidemically, or sporadically, and when it super- 
venes is both contagious and infectious. More common in 
males and the unacclimatized. One attack affords no protec- 
tion against another. 

The cause is malarial and paludal poison acting upon con- 
stitutions broken down by intemperance, excess, or non-accli- 
matization, aggravated by insanitary surroundings. 

Symptoms. — Often ushered in quite suddenly with languor, 
lassitude, debility, loss of appetite, giddiness, headache, and 
mental depression. At other times begins with coldness of the 
surface and distinct rigors, followed by fever which continues 
a few hours, then remits. In another class of cases there is 
prostration from the first, without any febrile reaction ; stupor, 



FEVER. 103 

coma, convulsions, soon following. When there is decided 
fever, we have an aggravation towards night ; pulse becomes 
quite wiry and frequent, skin hot and dry, eyes congested and 
painful, face flushed. Distressing headache, often confined to 
one temple, intense pains in large joints and limbs. Nausea, 
great irritability of stomach, vomiting, first slimy, then green- 
ish, then black — constant vomiting and retching. Tenderness 
on pressure over the stomach, liver, spleen, kidneys ; a sense of 
tightness or constriction across the chest. Thirst is intolerable ; 
great desire for cold drinks, only to be taken to be rejected. 
Urine diminished in quantity, highly albuminous, of a dark 
red color. Constipation, owing to an entire absence of bile in 
the stools. The restlessness is distressing; extreme mental 
anxiety ; sleeplessness, prostration, active delirium. Ai. the 
end of a few days severity of symptoms gradually diminishes, 
patient feels relieved ; face becomes slightly jaundiced ; skin 
becomes moist and there are copious biliary stools. In favor- 
able cases convalescence is firmly established. More frequently 
the improvement is of short duration. After a respite of 
twenty-four hours, epigastric tenderness is aggravated; jaun- 
dice increases and spreads over the entire body ; tendency to 
stupor ; pulse becomes feeble, irregular, slow, often as low as 
thirty beats per minute ; tongue becomes very foul and dry ; 
respirations embarrassed ; hiccough, thirst, nausea, vomiting, 
are constant. Unless symptoms remit, grumous blood is vom- 
ited — black vomit ; urine is suppressed or simply retained ; 
skin becomes of a dark brown hue; dark-colored blood is 
effused in patches under the skin, or exudes from the nose, 
mouth, gums, ears, anus, vagina. Most offensive ; tarry-looking 
stools. 

There are now all the symptoms of a malignant fever; almost 
imperceptible pulse, slow or stertorous breathing, involuntary 
evacuations, difficulty of deglutition and articulation, suppressed 
or bloody urine, with formation of buboes or patches of gan- 
grene. Death takes place preceded by coma or convulsions, or 
in some cases the patient retains his consciousness to the last. 

Its ordinary duration is from three to nine days. 

Death may occur from the overpowering effect of the poison 
on the system, exhaustion, uraemia, or apoplexy of brain, liver, 
spleen. 

Preventive Measures. — Removal of all nuisances or in- 
sanitary conditions; thorough ventilation of narrow courts, 
cellars, docks, warehouses, holds of ships. Cleanliness, removal 
of all waste matter, on board of ship pumping out bilge- water 
twice a day. Non-acclimatized individuals exposed should 
live on plain, nourishing food, avoiding alcoholic drinks and 
sexual excesses, and have abundance of sleep. To maintain 



104 FEVER. 

healthy action of the liver, skin, kidneys, and intestinal tract ; 
to wear flannel clothing, and not to be out of doors early in 
the morning or late at night. 

From the commencement to the end of an attack, the gen- 
eral indications for the treatment of a malignant type of fever 
should be carried out and rigorously enforced : recumbent 
posture strictly maintained, bed placed in the middle of a well- 
ventilated room, great attention paid to cleanliness, bathing, 
and disinfectants. Treat the urgent symptoms, guarding the 
patient through the difficulty. Simple diet, as arrow-root, 
barley-water, iced lemonade, broth, seltzer-water. Mustard to 
nape of neck and feet. Cloths wrung out of tepid water to the 
head for the relief of that terrible cephalalgia. The warm 
bath, or packs with water acidulated with nitro-muriatic acid. 
Patient packed in a sheet wrung out of that water. Ozone or 
nitro-muriatic acid water for a drink, occasionally turpentine 
cloths over stomach, liver, spleen. The factor in yellow fever 
is the germ or fungus, with high temperature, which is merely 
a consequence of the active disintegration that is going on in 
the blood. This high temperature is injurious by promoting 
disintegration in other ways. There are the best of reasons to 
keep down temperature by cold packs, for under an active 
refrigeration of the body the germ dies or becomes less active. 

If the attack begins with great irritability of stomach, the 
patient might drink tepid water with bicarbonate of soda, and 
the following given : 

Pulverized green lobelia, twenty grains; pulverized blood- 
root, twenty-five grains ; pulverized capsicum, thirty grains. 
Infuse in half a pint of water and take at two doses. After the 
emetic, the bath and enema. Then the patient placed in bed, 
and the administration of quinine and tincture of the green 
root of gelsemium commenced. Two important remedies. 

At the early stage there can be no doubt of the propriety of 
a large dose of quinine; later, small doses at considerable inter- 
vals. Given in large doses it produces cinchonism, which is of 
little consequence so that we get the blood saturated with the 
drug ; it should be given as a bisulphate in doses ranging from 
five to ten grains every half-hour ; later during the fever, when 
there is nausea and vomiting, in the following : sulphate of qui- 
nine, chloride of sodium, capsicum, of each thirty grains. Mak- 
ing six powders. One every three or four hours. With the 
first suspicion of the disease the tincture of the green root of 
gelsemium should be administered carefully and continuously 
along, keeping the patient under it so as to exhibit a decided 
physiological action, — double vision, thorough relaxation, re- 
freshing sleep, and an abatement of fever. The green root 
tincture holds in abeyance the active principles upon which the 



FEVER. 105 

germ lives or survives. If the quinine will not rest on the 
irritable stomach, give small doses of the oil of bitter almonds 
instead : one to two drops triturated on sugar of milk every 
three hours. If the nausea and vomiting be persistent, table- 
spoonful doses of the following : 

Vinegar, half a pint; common salt, a teaspoonful; capsicum, 
two teaspoonful s. Mix. 

If the fever does not yield to quinine, tincture of green root 
of gelseminum, or oil of bitter almonds, there is little to be 
hoped from the use of salicin and bebeeria. 

If stimulants are required, neither alcohol nor ammonia 
should be given; capsicum and camphor should have the 
preference. 

DENGUE. 

An epidemic, sometimes endemic fever, highly contagious and 
infectious, which prevails in the East Indies and along our 
Southern coast, Pensacola, Savannah, Charleston, Philadel- 
phia, and even so far north as New York. 

It receives quite a variety of names, such as break-bone fever, 
eruptive rheumatic fever, dandy fever, &c. 

Its cause is undoubtedly the same as yellow fever, to wit, 
malarial and paludal poison, probably modified by acting upon 
persons of a strong rheumatic diathesis. It is fully as conta- 
gious as yellow fever and requires the same attention to quar- 
antine and sanitary surroundings to prevent its spread or 
diminution. If due care is not exercised, a most extraordinary 
epidemic may be developed. 

The symptoms as seen in the rice-fields near Savannah are 
an eruption resembling scarlatina, with rigors and a fever com- 
bined, with the most intense rheumatic pains in the limbs and 
joints. 

There are also a strong biliary train of symptoms: nausea, 
brown-coated tongue, glands of the throat often implicated; 
lymphatic glands of neck, axilla, and groin swell, and the tes- 
ticles become enlarged. The pains in the joints of shoulders, 
arms, legs, and in the muscles, and, indeed, in all the bones of 
the body, are very great. The duration of the disease is about 
eight days. 

The usual treatment is by an emetic, sweat, and saline ca- 
thartic, followed with large doses of tincture of green root of 
gelsemium and quinine, and then the gelsemium alone in al- 
ternation with salicylate of soda, effects a rapid cure. 

VCe witness a curious fact in this disease as well as in other 
contagious diseases, — its mildness when confined to a given race, 
but spreading from that race to others, remarkable for its fatality. 



106 FEVER. 

ERYSIPELAS. 

A specific inflammation of the skin or cellular tissue, or both. 

Cause. — A partial death of the organs of digestion and as- 
similation caused by isolation, overcrowding, sameness, mo- 
notony, deleterious food, and other depressants to the normal 
living matter concerned in nutrition, altering, changing, or 
degrading it into the living germ bacteria, which is taken up into 
the blood, in which fluid it has wonderful growth and power of 
duplication. 

Symptoms. — Languor, lassitude, debility, pain in the head, 
back, and calves of the legs, tongue coated with a heavy brown 
coat, usually constipation, albumen in urine, rigors, and a high 
grade of fever, either prior to the rigor or sometime subsequently 
an inflammation of the skin. This inflammation of the skin 
occurs because the bacteria in the blood have used up in their 
own [growth a nutrition and multiplication of all the oxidiz- 
able properties in the blood, and are in danger of starvation, 
and are becoming weak and attenuated and seek the surface to 
have access to free oxygen. On the skin they become extremely 
vigorous, fresh life being infused into them as well as unpre- 
cedented growth, hence the spreading. They always select a 
portion of the skin that is weak or devitalized, as there the ves- 
sels are more loose and patulous and they can find their way to 
the surface easier. They will not come to the surface so long as 
they can get fresh oxygen in the blood ; let this, their pabulum, 
become exhausted, and they soon appear. 

It is easily recognized by its symptoms, bacteria on tongue, 
and the inflammation having a tendency to spread widely. 

In treatment, an emetic of lobelia, alcoholic vapor bath, and 
a free action of the bowels with antibilious physic. General 
treatment for fever. Tincture of aconite, veratrum, green root 
tincture of gelsemium, sweet spirits of nitre, of each a teaspoon- 
ful to half a tumbler of water ; one teaspoonful every half-hour 
till pulse reaches 70, then every two or three hours. 

Then internally and locally, antiseptics ; for internal use, 
brewers' yeast and sweet milk, or ozone-water, or chlorate or 
permanganate potash, or sulphurous acid, or tincture of iodine, 
or salicylate soda. 

Locally, tincture of iodine and lime-water, solutions of borax, 
sulphite soda, permanganate potash. Use one of these lotions, 
Apply by cloths kept constantly wet and covered with oiled 
silk. 

To parts where a lotion cannot be advantageously applied, 
the following may be used : 

Take four ounces of glycerine, two teaspoonfuls of finely 
pulverized gum tragacanth, and a quarter of an ounce of iodo- 
form. Mix. 



FEVER. 107 

Spread on old linen and apply. Change every three hours. 

We say again, give and apply antiseptics freely, liberally, 
persistently; give them and the fever will abate, the tongue will 
clean, the gastric symptoms will subside — they kill the germ, 
the source of disease, the factor of fever. 

Convalescence upon tonics, diet, fresh air, &c, cinchona and 
nitro-muriatic acid. 

DIPHTHERIA. 

In the human blood we have living matter or bioplasm that 
gives nourishment to bone, brain, skin, muscle, every gland 
and structure in the body. This living matter is capable of 
being changed, altered, or degraded by adverse circumstances 
into other living matter, which is capable of an independent 
existence in and out of the body, provided heat, moisture, and 
elements of nutrition exist. The degraded bioplasm of ordi- 
nary nutrition becomes bacteria, that of nerve-forming matter, 
vibrios, &c. In the vegetable as well as the animal kingdom, 
we see this tendency to degradation going on when suffering 
adverse conditions. Among vegetables, cereals, plants, and 
trees, when the soil is poor or exhausted, a change of their nor- 
mal living matter takes place which is termed a blight, or rot, 
it being simply a change or degradation of the cell-elements of 
the organism of plant, cereal, or tree. We see daily examples 
in the potato, grape, pear rot, in grain of spurred rye, or corn 
smut. In the human body, when vital force is tremendously 
shattered or suffers very great deterioration, when humanity 
is a wreck, or whittled down to a very low ebb, we too take the 
rot or blight — a degradation of our own normal elements into 
a living germ, oidium albicans. This micro-organism is best 
seen in the false membrane of diphtheria, and presents a per- 
fect or characteristic myceli and spores. The former are 
like tubes with partitions at intervals. These, under favorable 
circumstances, elongate, bifurcate, the bifurcations being pecu- 
liar in consequence of their incurved branches like the sides of 
a lyre. The mycelia multiply rapidly, and when a large mass 
of them is collected together, look like tall-growing flowers. 

When the health is feeble, we often can detect isolated spores 
on the lips, tongue, nipple. The human rot has no doubt ex- 
isted from time immemorial, although its destructive devasta- 
tion was first exhibited in several villages in the south of 
England, in 1854-55 : localities in which intermarriage was 
very common, and their drinking-water highly calcareous, and 
as a consequence, children tuberculous. From that time up to 
the present the disease has spread by spontaneous production, 
infection, and contagion, over the entire world. 

As the term rot is not congenial to the ears of the refined or 



108 FEVER. 

fastidious, those pusillanimous members of modern society, it 
has been dignified by the name diphtheria — a sporadic, epi- 
demic, endemic, contagious and infectious disease, due to living 
disease-germs, the result of degradation of normal bioplasm, 
causing toxaemia and death. 

When the vital forces in children are very feeble, especially 
if the surroundings are bad, as dirty, damp, badly-drained 
abodes, it may break out spontaneously ; if so there is usually 
great prostration ; when received by contagion or infection, it 
comes on slowly and insidiously, with languor, lassitude, de- 
bility, headache, pain in back, calves of the legs, rigors, fever 
of a continued type ; tongue heavily coated, brown, dark at 
root; rarely diarrhoea; mental condition dull, stupid, drowsy; 
heat, pulse, and respirations high ; face flushed; skin hot ; often 
delirious. Tonsils become inflamed and swollen ; the parotid 
and other glands sympathize. Inflammatory action spreads to 
the uvula, fauces, pharynge, deglutition becomes difficult; 
if it is not properly arrested, a soft, plastic exudation or 
growth, vesicular in shape, fibrinous in character, is devel- 
oped on the mucous membrane, in which millions of the living 
oidium. albicans are lodged or imbedded. At first this growth 
looks like little vesicles or blisters, white at first, then ash- 
colored. They speedily coalesce and form large patches re- 
sembling dirty, damped, washed leather; if vital force is very 
low they grow with extreme rapidity. As they increase in num- 
bers they also increase in size, extent, and thickness, firmly 
adherent to the mucous membrane beneath. If forcibly re- 
moved a new patch is at once formed, and this colony will 
grow; besides, the breath, urine, stool, are loaded with young 
germs which are very light, so much so that they may alight 
on the cheek, gums, glottis, conjunctiva, vagina. When the 
germ dies, membrane becomes gangrenous, sloughs separate, 
decomposes, and the breath becomes terribly offensive. When 
the mass is thrown off there may be sloughing or gangrene, or 
if vital force be well sustained, the tissues around may acquire 
a healthy appearance. In cases of extreme prostration it may 
appear on the cutaneous surface. 

The constitutional symptoms vary much, the breath being 
very fetid, and occasionally hemorrhages from nose, fauces, 
bronchi. 

Albuminuria in diphtheria is due to the action of the mycelia 
on the blood and to the fact that the kidneys are literally 
crammed full of the disease-germs. Death may take place from 
exhaustion, uraemia, hemorrhage, gangrene, asphyxia, embolism. 
In the event of recovery itis tardy, sequelae being anaemia, nerve- 
affections, paralysis, sleeplessness, impaired or defective sight or 
hearing. It is apt to leave a weak or hoarse state of the voice. 



FEVER. 109 

As a pure isolated condition of rot in this country, diphtheria 
is not so common as in Europe, but our people are so restless 
and improvident of all sanitary measure's that when it does 
occur it has a free, unlimited scope, as the poison is permitted 
to enter drinking-water through sewers, and contaminate our 
food by exposure. It may be true that the needs of society in- 
crease as they become more densely populous, and the isolation 
of the sick is more difficult. 

Cases could be cited of cows with foot-disease (oiaium albi- 
cans) imparting the germ to their milk, causing diphtheria; to 
milk exposed attracting the germ, propagating the disease ; to 
cases of aphthse and ulcerative stomatitis, causing diphtheria. 

Its duration is from one to two weeks. 

If the vital forces fail, choking and suffocation come on ; the 
sufferer tears at his neck with his nails, and tries to open his 
mouth; retains power of swallowing; purpuric spots on ex- 
tremities; muttering delirium, convulsions, and death. 

It is easily recognized by the fever, stupor, dark coat on 
tongue, odor of breath, and this germinal growth on the mu- 
cous membrane on fauces, tonsils, first as vesicles latterly the 
formation of a false membrane. 

The oidium albicans destroys the blood-discs and gives rise 
to the diphtheritic patches on mucous membrane. 

In the Treatment the general indications for the treatment 
of a highly contagious fever should be carried out. 

Patient placed at once in a well-ventilated room with anti- 
septics exposed. Bathing should at once be commenced, and 
performed thrice daily. The diet nutritious, — essence of beef, 
white of egg, cream and wine. An effort must be made to 
equalize the circulation, with tincture of aconite, belladonna, 
and veratrum. Then place the patient under antiseptics. Sul- 
phur is most terribly destructive to the germ; flowers of sul- 
phur in water as a gargle and internally, or blown through a 
quill on the membrane ; raw beef to the throat changed thrice 
daily and subsequently burned. The tenderloin being more 
highly organized, is the best attractor of germs, — if not that, 
vaseline or ozone ointment. Inunction of vaseline or ozone 
ointment into the entire body after the evening bathing often 
operates like magic in the case. Chlorate of potassium and mu- 
riatic acid and sulphurous acid and quinine, as administered 
in scarlatina, should also be given here. If the sulphur is not 
used then paint the colonies or patches with tincture of iodine 
and carbolic acid, — four parts of the former to one or two of 
the latter. Yeast and milk is excellent, or a solution of pepsin 
crystals makes an excellent local application, otherwise the case 
must be treated on general principles, keeping in mind its cause, 
adhering to an antiseptic and constructive treatment through- 



110 FEVER. 

out. The oidium albicans or diphtheria germ proper is a great 
factor in disease; it is the disease-germ of spotted fever, ozcena, 
aphthse of the mouth and nipple, of gangrene of scrotum and 
labia, ulceration at matrix of nail, gangrene or rot, generally 
invariably contagious and infectious. Other remedies are often 
used with great success, as pepsin added to milk ; permanganate 
potassium, one-half grain ; equal parts of tincture of iron and 
tincture of iodine painted over the germs on mucous mem- 
brane. 

The constitutional treatment should be of the most construc- 
tive kind, — all forms of liquid nourishment. In all cases qui- 
nine and aromatic sulphuric acid. The selection of a proper 
antiseptic, one capable of destroying the factor, the germ, is of 
the utmost importance. 

SPOTTED FEVER, OR EPIDEMIC CEREBRO-SPINAL 

MENINGITIS. 

An irritation of the brain and cerebro-spinal axis by the 
presence of the disease-germ oidium albicans in the blood. 

In states of the human body in which vital force is at a very 
low ebb, shattered almost irreparably, and this is aggravated 
by diminished electrical or perverted meteorological condition, 
a rot or degradation of normal living-matter into the disease- 
germ, the oidium albicans. 

It attacks persons of all ages, with broken-down or devital- 
ized constitutions. It is prevalent all over the world, and cor- 
responds precisely to the blight in the vegetable kingdom, con- 
tagious and infectious. 

It comes on slowly and insidiously, preceded by an unde- 
termined period of incubation or germination, followed by 
rigors and a fever which last from five to seven days. The 
prostration and coma are extreme; head and heels thrown 
back; often livid or purple spots on the body, sometimes ab- 
sent ; otherwise the skin is remarkable for its pallor ; flush on 
cheeks. Often convulsions. 

Its duration is five clays; recovery in all cases very doubtful. 

There is a tendency for the different types of remittent to 
terminate in cerebro-spinal meningitis. 

Its recognition is easy, — its insidious mode of attack, the coma, 
high fever, head and heels thrown back, livid spots on the skin, 
violent and short duration of fever. 

If seen early, the ordinary treatment of fever by emetics, 
cathartics, and diaphoretics is admissible; arterial sedation with 
aconite and veratrum, and sponging. Diet, beef-essence and 
milk. Active stimulants over the cervical portion of spinal 
cord, with galvanic cautery or ice, followed by hot poultices or 
a liniment of tincture of belladonna, chloroform, and aqua 



FEVER. Ill 

ammonia, equal parts. Secretions kept active. An effort must 
be made to suspend the impressibility of the medulla oblongata 
by the administration of the following: 

Camphor-water, four ounces ; bromide of potassium, half an 
ounce ; tincture of calabar bean, half an ounce ; bicarbonate of 
potassium, thirty grains. Mix. 

A tablespoonful every hour. 

If we can control the fever and suspend the impressibility of 
the cerebro-spinal axis, one point is gained. The other is to 
destroy the germ in the blood with antiseptics, for that fluid is 
but a living mass of bacteria and oidium albicans. Probably 
half-grain doses of permanganate of potassium in water, every 
two hours, is more rapidly assimilated than the chlorate and 
muriatic acid, or iodine and carbolic acid. 

Otherwise the fever should be treated on general principles. 

PUERPERAL FEVER. 

A pregnant woman, from her innate modest}', houses up a 
good deal, and as a consequence there is an insufficient aera- 
tion or oxygenation of her blood. The gravid uterus presses 
the liver, which causes an imperfect decarbonization of that 
fluid ; the two states combined render the blood very fibrinous, 
black, clotty, and full of bacteria. 

The anterior portion of the uterus in all highly civilized 
women is very liberally covered with branches of the great 
sympathetic. Now suppose some depressing emotional condition 
is brought to bear on the case, as a blighted affection or passion ; 
this would very naturally cause a weakness, an inertia, a de- 
bility of the uterus, which would likely render it unable to ex- 
pel the placenta or membranes, or lochia, which would then be 
retained and undergo decomposition, and be readily absorbed 
by the mucous membrane of the vagina and uterus, — by the 
placental attachment and other wounds in the genito-urinary 
tract, or the products might pass directly into the sinuses of 
the uterus and thus into the blood, and cause puerperal fever. 
This is the common mode of origin : a depression of the great 
sympathetic the predisposing cause, and the exciting, absorption 
of the products of parturition. As it is extremely contagious 
and infectious, it may be received in that manner. The attend- 
ing physician or nurse may have the germs of a former case in 
their hair, nails, clothes, and singular but nevertheless true, 
that the disease-germs of peritonitis, scarlatina, erysipelas, dis- 
section miasmata, will give rise to it. The cause is supposed to 
be a dual germ, the bacteria- vibrios, which has most wonderful 
tenacity of life if brought in contact with hair or feathers or other 
animal matter. 

Symptoms. — From a few days to a week after confinement 



112 FEVER. 

seems to be about the usual time necessary for its development. 
It comes on with rigors and a very high grade of fever, with a 
wiry pulse, anxious expression of countenance, prostration, and 
the symptoms of fever in an aggravated form ; abdomen usu- 
ally distended, and some tenderness on pressure. Lochia and 
secretion of milk suspended. The course of the fever is very 
variable — sometimes rapid death from blood-poisoning; mother 
cases violent acute metritis, complicated with peritonitis and 
gastritis with extreme tympanitis or diarrhoea, phlegmasia 
dolens, phlebitis, or pelvic cellulitis and abscess. 

Usually in puerperal fever we have a group of diseases which 
dovetail into it, all swarming with the germs of disease, which, 
when combined with the mental state of the patient, render 
the mortality very great ; besides, its death rate is often increased 
by insanitary surroundings. 

Its duration is short, its fatality great; the double germ 
origin of the fever occurring in the weak, the unhealthy, the 
forsaken, the hopeless, the sad, or in those exhausted by a long 
difficult labor, render it very hopeless. 

Treatment. — In this fever, with its dual micro-organism, 
there must be no folding of the hands in listless apathy and 
inaction, but there must be unceasing, unremitting activity. 
The danger is great, and we must face it boldly. Strengthen, 
heal, console, encourage, manage labor carefully so that inju- 
ries be reduced to a minimum, are objects never to be lost 
sight of, and if in attendance on a case of fever, or erysipelas, 
or peritonitis, scarlatina, or near a dissecting-room, do not enter 
the parturient chamber. Prevention is better than cure. The 
house in which the patient lives is tainted, and all puerperal 
women in the vicinity are in danger; the infection is intense; 
no article of clothing, no carpet, no curtain, escapes the lodg- 
ment of the germ. It nestles everywhere, and so tenacious are 
they that they will dog the steps of the physician or nurse for 
at least six months. 

Ventilation, cleanliness, antiseptics,, and a strong, buoyant, 
hopeful condition in the patient are our great safeguards. So 
long as woman's high moral nature exists and is susceptible to 
shock, so long will puerperal fever rage without infection or 
contagion. 

For its treatment, rest, bathing, and general principles are to 
be inculcated. We can destroy the germ, moderate the fever, 
although we cannot repair a broken heart. The administra- 
tion of as large a dose of the tincture of the green root of gel- 
semium and a solution of the sulphate of morphia as the 
patient can bear, is good treatment, pushed even to narcotism ; 
it seems to arrest the incessant growth of germs. The uterus 
and vagina should be washed out three times a day with 



* FEVER. 113 

carbolic acid and tepid water, or boracic acid and infusion of 
chamomile flowers, as long as there is odor. 

Turpentine should be applied over the entire abdomen, and 
followed with olive oil and opium, or vaseline, or ozone oint- 
ment, and reapplied as soon as the redness disappears. We 
place great confidence in narcotism with opium and green root 
tincture of gelsemium, producing a quasi suspension for twelve 
or fourteen hours, so that the germs will be deprived of their 
proper pabulum and thus cause their death. If narcotism can 
be successfully produced, the patient, if well managed, is likely 
to recover. It is difficult to explain the why and the where- 
fore, but true narcotism is a beacon light in germinal disease. 
We have no antiseptic capable of killing the germ of snake- 
bite, or rabies, or yellow fever. We must produce a quasi sus- 
pension — in statu quo — an arrest of pabulum, and the germ 
almost instantly dies in the body ; so in puerperal fever. 

Double vision, profound muscular relaxation are to be reached 
with the gelsemium green root tincture, and with regard to the 
opium, the practitioner will select some form that is easily 
assimilated, and to which there is no idiosyncrasy (hypodermic 
injections are not admissible). Give often so as to act speedily, 
and procure thorough narcotism, which is manifest by sterto- 
rous breathing, profuse colliquative sweats. 

The liver must be brought into an active condition ; for this 
purpose fifteen grains of calomel should be given every hour 
until free biliary stools are passed, its action aided with salines. 
Boracic acid or salicylate of soda should have a trial as an 
internal antiseptic. 

At night poultices of linseed meal are grateful and soothing, 
over the entire abdomen. 

If the physician keeps carefully in mind that in this fever 
he has blood-poisoning, the growth of micrococci by millions, 
blood-poisoning by absorption, and a fever traumatic of a shock 
to the uterus, he will have little difficulty in treatment. 

Good results follow the use of germicides, a teaspoonful of the 
carbolic acid and tincture of iodine mixture, or else one table- 
spoonful of brewers' yeast in milk. 

ANTHRAX— MICRO-ORGANISMS— GIANT 
BACTERIA. 

The alteration or change, or modifying, or degrading of the 
normal living matter concerned in the nutrition of animals, 
such as the horse, cow, sheep, goats, camels, and also poultry, give 
rise to a micro-organism, a giant bacteria, capable of wonder- 
ful power of multiplication or production in the blood of the 
affected animal, which may die, and during its life and after 
death when buried in the earth mav communicate it to man or 



114 FEVER* 

other animals, or it may be disseminated with the hair of the 
animal into plaster, or mattresses, or the wool or hair of the 
diseased animal may be converted into cloth and infect all 
who handle it or are near to it, or even wear it, after being re- 
duced to a textile fabric. When it occurs, whether in man or 
animals, it is essentially contagious and infectious. 

The inquiry into the nature and cause of this fatal malady 
commenced in 1870, and was specially directed to the elucida- 
tion of the disease in its three aspects, external and internal, 
with bacterial poisoning. Without any lesion cases of sudden 
death in a few hours, of apparently healthy persons without 
any real cause, excited the minds of the philanthropic. Three 
healthy children in one house, one dying after another in a few 
hours, men and women very suddenly stricken down with ob- 
scure blood-poisoning, and the etiological identity of their 
symptoms traced to the disease so common and so fatal in alpaca 
and mohair factories. 

The disease is quite common, and can be traced to the ani- 
mals enumerated, or their hides or wool. 

Anthrax or malignant pustule has been known for centuries 
as affecting animals and from them to man, but it is only of 
recent years that an internal or latent form has been suspected. 
The first striking epidemic that was observed in this country 
was an outbreak among horse-hair workers in a mattress fac- 
tory ; another among blanket-weavers, and others among tan- 
ners and butchers. The medical profession have been so dog- 
matically ignorant that they failed to recognize it, and deaths 
resulting from it have been rated as malignant smallpox. Its 
real or prevalent appearance in this country dates from the high 
tariff and the inauguration of the manufacturing of alpaca in 
1866, and it has become more aggravated since the introduction 
of van mohair in 1872. Cases have become more numerous 
and often fatal within a few hours. Residents in the neigh- 
borhood of these factories are justly alarmed, the operatives are 
looked upon with suspicion and shunned and their occupation 
deemed dangerous. 

Another source of contagion and infection is from domestic 
cattle, especially sheep; their wool is obnoxious. Tanners, glue 
factories' operatives suffer intensely. Land to which the debris 
or refuse of glue factories is applied for a manurial product is 
likely to become a centre of contagion. Farmers pay a high 
price for such refuse, and if mixed heavily with lime and 
ploughed under there may possibly be no danger, still it is well 
not to be applied to grass-fields as a top dressing. 

One thing is certain, the disease is very prevalent among 
animals, terribly fatal, and when man receives the contagion 
or infection he seldom recovers. The hair or wool is the focus 



FEVER. 115 

of distribution, textile fabrics to a limited extent, but as our 
manufacturers are aiming at the introduction of a class of 
goods for which they are importing largely from Asia, hair or 
wools, the health of the community is endangered thereby. 

Anthrax may attack man in three different ways, — malig- 
nant pustule, anthrax oedema, and internal anthrax. 

The malignant pustule is usually the result of inoculation, 
and is most frequently met with on the hands, arms, face, and 
neck, or some exposed part of the body, and commences as a 
small red point or pimple, which may be painless or attended 
with a stinging sensation like that of a wasp-sting. A small 
papule speedily forms, which becomes covered by a flat vesicle 
which enlarges and usually bursts, discharging a clear bloody 
fluid ; a central black eschar forms at the base of the discharged 
vesicle, and a crop of other smaller vesicles form around it. The 
surrounding tissue becomes inflamed, so that the vesicle is 
seated on a hard base, with a sort of erysipelatous blush and 
swelling extending for a considerable distance. 

The central eschar enlarges and the corona of vesicles as well 
as the inflammatory sore enlarges and the oedema becomes 
quite great, so much so that if seated on the face, the head, neck, 
and shoulders become involved in the general doughy swelling. 
The lymphatics of the neck are seriously involved. 

If the patient weathers the crisis, the central slough sepa- 
rates and the wound granulates and heals. 

The constitutional symptoms are those of a malignant poison, 
— rigors, high fever, nausea, vomiting, prostration, sleepless- 
ness, labored breathing, exhaustion, and delirium. 

Death may occur early or not for several days. 

Internal anthrax is as rapidly fatal with or without internal 
lesions. It is usually brought about by the bacteria giant cells 
finding their way into the blood by the air, food, and water. 
Lesions or rather colonies .of the micro-organisms are found in 
the bowels, liver, spleen, brain, and blood. 

The symptoms of the internal are prostration, vomiting, 
dysphagia, pain, uneasiness in abdomen, colic, and diarrhoea, 
the latter often bloody from the first; collapse, and cyanosis. 

Death is often quick. 

The symptoms of the form without internal or external 
leisons are those of extreme prostration, and malignancy. 

After death in any of the forms the blood is found filled with 
large bacteria. Thrombosis of blood-vessels by masses of 
bacilli, not uncommonly an artery or vein being filled with a 
clot or plug loaded with germs. 

The recognition of anthrax is often difficult and obscure, 
unless we have a good history, as a wool-sorter, butcher, tanner, 
or hair or wool operative or an attendant upon diseased cattle, 



116 FEVER. 

or using water into which the refuse of an alpaca factory 
empties for a drink, or baler of fleeces. 

The pathology of the disease can only be well studied in a 
factory in which wool is used, especially alpaca or mohair, or 
the fleeces of our own animals who have died from it or any 
other disease. The mode of sulphur steaming resorted to in 
our domestic wool destroys the bacilli ; this not being done in 
imported fleeces renders them capable of disseminating the 
most dangerous and virulent of bacterial poisoning so far 
known to the profession. 

The use of analine dyes is incapable of destroying the germs, 
so that some of our cloth is also contaminated with bacilli, and 
capable of spreading the disease. The imperfect method of 
tanning hides into leather has been productive of the disease. 

A remarkable case occurred in 1881. A cow died from 
anthrax. Instead of burying it deep in the earth, far from 
wells, a manure-heap was piled upon it ; in due season the 
manure was spread over a pasture field. It was so thoroughly 
incorporated with a prodigious number of disease-germs from 
the carcass of the cow, that when a herd of five hundred sheep 
were let into the pasture, all died inside of thirty-six hours 
from anthrax. 

The production of anthrax among our domestic animals is 
an evil of grave importance, seriously injuring commerce as 
well as destroying human life, and is so easily prevented in 
animals by good care, plenty of healthy food, an avoidance of 
overcrowding and all insanitary conditions, and an abundance 
of pure water, that farmers can easily get rid of it. Indeed, the 
greatest care should be taken of our water supply ; no wool fac- 
tory or tan-yard should on any consideration empty its contents 
into a river or near a well. 

The treatment of anthrax should be carried out on general 
principles, and our most powerful antiseptics freely given. The 
disease runs its course with such fearful velocity that there is 
little time to experiment. In the salicylate of soda we have a 
remedy capable of destroying the smallpox germ, arresting all 
process of fermentation, so definite, and some are so sanguine 
of its effects that they think it will destroy the living germ of 
rabies, and why not that of the bacilli of anthrax. 

Ozone water is another remedy of great power, and so is a 
solution of permanganate of potash, which is capable of des- 
troying the poison of the most virulent snake. 

SURGICAL FEVER. 

This fever has been defined to be a condition of imperfect 
reaction — a salutary effort of nature at recovery or repair; idio- 
pathic, which is caused by a poison or germ operating within 



FEVER. 117 

the body, either inhaled or generated within ; symptomatic or 
surgical fever, which is caused by a shock, a local injury, re- 
flected to the brain. 

Since the introduction of anaesthetics, surgical fever has 
assumed a very mild type, and in the large percentage of oper- 
ations is entirely absent. 

The cause of surgical fever is a local injury, or violence, or 
surgical proceeding that depresses the vital powers. It may 
assume five different forms or types, simple surgical fever, irri- 
tative fever, intermittent, hectic, and typhoid. It receives one or 
other of the above names, according to the train of symptoms 
and morbid condition present. 

Simple Surgical Fever. — Languor, lassitude, debility, pain 
in the head, back, and calves of the legs, rigors, and a fever of 
a continued type. 

When the patient is irritable, restless, feverish, sleepless, and 
the injury is to a nerve or vein, it is called irritative; when it 
occurs in paroxysms, like ague fits, which condition seems to 
be associated or dependent upon operations upon organs con- 
tained within the cavity of the pelvis, it is termed intermittent; 
if the vital forces are very low, urine copious and of a low spe- 
cific gravity, with a morbidly clean tongue, flush on cheeks, 
burning in the palms of the hands and the soles of the feet, with 
profuse sweats, it is termed hectic ; if the powers of life are still 
lower, we may have that degradation of normal bioplasm, vi- 
brios, termed typhoid. 

The treatment of these different types of surgical fever must 
be upon general principles. The circulation must be con- 
trolled effectively with arterial sedatives. We must enforce 
hygiene and nursing, supporting the patient carefully, and 
well watching and guarding all complications as they arise. 

1. In the simple form, rest, veratrum, aconite, bathing, nour- 
ishment, &c. 

2. If of an irritative type, anodynes, extract hyoscyamus, 
opium, &c. 

3. If intermittent, quinine, gelsemium, iodine, salicin. 

4. If a condition of hectic supervenes, stimulants, tonics, 
nourishment, aromatic sulphuric acid and quinine. 

5. If typhoid symptoms, treat same as typhoid fever. 

In all cases of surgical fever, the grand point is to blunt the 
impressibility of the nerve-centres ; in this manner the severity 
of the fever is greatly mitigated. It is therefore of great im- 
portance to administer anodynes and arterial sedatives freely. 
A constructive or building-up treatment is of essential im- 
portance, and the general principles as laid down under the 
head of fever, rigidly enforced; especially bathing, rest, and a 
free use of antiseptics. 



118 



ERUPTIVE FEVERS. 



ERUPTIVE FEVERS. 



Continued Fevers Characterized by a Rash. — The prin- 
cipal diseases of this class have some features in common ; they 
are each due to the presence of a living germinal poison in the 
blood, which has a definite period of germination, called incu- 
bation ; they are accompanied with fever, which runs a precise 
course, are attended with an eruption, at which period the 
germ seeks the surface for oxygenation, where they either de- 
stroy the cuticle and peel off, or gather in colonies and form 
vesicles, pocks, or scabs; that those changes are regular and 
definite — for the most part, the germ uses up in its own nutri- 
tion and growth certain elements in the blood, which seldom 
if ever aggregate in that fluid again; hence, as a general rule, 
the patient is subject through life to but one attack. 

They all arise from a special germ, whose progress can be in 
some measure arrested or cut short, their severity mitigated, 
modified, and even abridged by proper remedies, thorough 
nursing, and attention to certain rules. 

The diseases of this class are measles, rotheln, scarlatina, and 
small-pox. 



Disease. 



Measles 

Scarlet Fever 

Small Pox. .. 



Germination. 



10 to 14 days. 
4 to 8 days. 

12 days 



Eruption appears. 



4th day of fever 
2d day of fever.. 

3d day.of fever . . 



Eruption fades. 



7th day of fever. 
5th day of fever. 
( Scabs form on 9th day, 
(fall off 14th to 22d day. 



If either of the above three forms of eruptive fevers are con- 
veyed from an opposite or antagonistic race of men, the germ 
takes on inordinate activity and malignancy. 

MEASLES, OR RUBEOLA. 

A continued or infectious fever preceded by catarrhal symp- 
toms, as sneezing, watering from the eyes and nose, accompa- 
nied by a crimson rash, and often attended or followed by 
inflammation of the mucous membrane of the organs of res- 
piration. The cause is a specific germinal poison. 

Symptoms. — After a period of germination, varying from 
ten to fourteen days, there is pain in head, back, calves of the 
legs ; lassitude, shivering, fever, and catarrh, the eyes are suf- 
fused, lining membrane of the nose congested ; mucous mem- 
brane of the fauces, larynx, trachea, and bronchi become 
much affected; eyelids swollen, keep watering, intolerance of 
light; sneezing, nose running water; dry cough, hoarseness ; 
difficulty of breathing ; drowsiness ; great heat of skin ; ten- 
dency to delirium; frequent, hard, rapid pulse; tongue white- 



ERUPTIVE FEVERS. 119 

coated. The eruption comes out on the fourth day of fever, 
usually first on the face, then the body, and lastly the limbs, 
fading on seventh day; it consists of patches, rough, irregular, 
elevated above sound skin, often of a round or crescentic or 
horse-shoe shape. Between the crescentic blotches the skin is 
of the usual color. Fever does not abate on the appearance of 
the eruption. There is no peeling or desquamation of the 
cuticle, which is a characteristic in scarlatina. Diarrhoea often 
sets in on the declining of the rash. It is usually salutary. 
The contagion of measles is strong, being powerful through 
both its latent and active form, often pulmonary complications, 
especially in winter and spring months. 

If the patient is tubercular, or the disease comes from another 
race, there may be laryngitis, cancrum oris, severe otitis, 
epistaxis, acute tuberculosis, or acute desquamatic nephritis. 
In a malignant form, when powers of life are low, the disease 
is remarkable for its fatality. 

Treatment. — Confine the patient to bed, in a warm, airy, 
darkened apartment; enjoin hygiene; have him carefully 
sponged thrice daily with warm alkaline wash, or warm vin- 
egar and water ; put one teaspoonful of tincture of aconite and 
belladonna into half a tumbler of water, and give one tea- 
spoonful of it every hour. Compound tincture of serpentaria 
should be given, thirty-drops every three hour in sweet mar- 
joram tea. No cold drinks. Give the following to destroy 
germ : 

Chlorate potash, muriatic acid, of each, two drachms added 
to four ounces of water. One teaspoonful in sweetened water 
thrice daily, and anoint the body with vaseline ointment. 
Diet, beef tea, milk and lime-water. If cough be troublesome, 
give small doses of ipecac. If there be debility, nourishment 
and stimulants. If there is any tendency to delirium or con- 
vulsions, bromide of potash in ten-grain doses, with warm foot- 
bath, drying well and applying dry mustard to feet and limbs ; 
otherwise the case should be treated on general principles. 

RUBEOLA NOTHA, OR ROTHELN, 

This has been supposed to be a compound of measles and 
scarlatina ; but it is neither, nor a hybrid, but a special disease, 
due to a disease-germ, and appears to be more common in the 
early summer months — but no period of the year seems to be 
exempt from it. Like all diseases due to a micro-organism, it 
is both contagious and infectious. 

Symptoms. — There are the ordinary symptoms of languor, 
lassitude, debility, rigors, and a fever, which often runs high ; 
tongue is furred ; slight sore throat, redness of the fauces ; little, 
if any, coryza, loss of appetite, drowsiness, looks heavy, eyes may 



120 ERUPTIVE FEVERS. 

be red but do not water. The skin is full, tense, and raised, 
and a papular rash makes its appearance, which gradually 
intensifies in color and becomes of a bright rosy hue — these 
patches become blotches, and gradually spread over the entire 
body. The rash that comes out first soon fades and other patches 
make their appearance; the rash is followed by dryness of the 
skin. 

In mild cases there is simply the rash without the least con- 
stitutional disturbance, appetite good, tongue clean, no languor, 
rigor, nor fever — nothing but a few tiny spots; larger spots or 
blotches of a rosy hue in one part, at the elbows and knees, and 
spots and blotches on the hands, arms, and legs; the redness 
and soreness of the throat scarcely appreciable, the rash may 
be gone in a day. Sometimes the cuticle peels, but as the con- 
stitutional vigor is good, he eats and sleeps well. Between a 
severe and mild case, Eotheln varies much in character and 
severity. Most frequently it presents no symptoms but the rash, 
or the patient may be quite sick, and the rash varies much, ap- 
pearing like measles ; in other cases diffused, or but a few sparsely 
scattered rosy-red minute dots; in others a perfect aggregation. 

It is highly contagious and infectious, but its stage of incu- 
bation, fever, and eruption has not been defined. The worst 
case seldom lasts longer than three days. One attack protects 
the patient from all subsequent ones. It is followed by no 
sequels, and most invariably terminates in recovery. 

The treatment consists in the warm bath, rest in bed be- 
tween blankets, warm drinks, sweet marjoram. 

Aconite and compound tincture of serpentaria, aromatic sul- 
phuric acid and quinine, destroys the germ promptly, and 
should be given as soon as the skin is moist from the action of 
the aconite. 

The child should be kept at home a few days, as the affection 
is even more contagious than measles or scarlatina. No after 
treatment is necessary. 

SCARLET FEVER. 

Scarlatina, an infectious fever, characterized by a scarlet 
efflorescence of the skin and mucous membrane of the fauces 
and tonsils. 

Cause. — A specific germinal poison. 

There are three grades or types of this fever — three different 
degrees of intensity of one poison, depending in a great measure 
upon the amount of germs inhaled and power of vital resist- 
ance on the part of the patient. 

The three forms or grades are : Scarlatina simplex, in which 
vital force is good, and germs appears most on the skin; Scarla- 
tina anginosa, vital force low, and germs abundant, in which 



ERUPTIVE FEVERS. 121 

the skin and mucous membrane of the throat are severely im- 
plicated ; and Scarlatina maligna, in which vital force is fear- 
fully shattered, and there may be death in two or three days, 
with cerebral symptoms, or the fever may have an adynamic 
type; rash, if any, dusky or purple, with a tendency to sup- 
puration. 

In Scarlatina Simplex the symptoms are a latent period 
of from four to six days, with languor, lassitude, debility, pain 
in head, back, calves of the legs, and also rigors and a fever. 
On the second day the eruption appears in the form of innu- 
merable minute dots of a bright scarlet color, which rapidly 
diffuses itself over the entire body. This eruption terminates 
by desquamation of the cuticle, which takes place on the fifth 
day. It is merely a scurf on the face and trunk, while on the 
hands and feet large flakes of denuded cuticle peel off. While, 
or even before, the efflorescence is spreading over the entire 
body, the mucous membranes of the mouth, fauces, and tonsils 
become affected ; the tongue at first covered with a thick white 
fur, through which red, elongated papillse project; as the fur 
cleans off, the organ presents a strawberry appearance. 

In Scarlatina Anginosa the symptoms are more violent, 
very much aggravated, and the languor, rigors, and headache 
very great; fever high, vomiting, delirium, and prostration. 
The fauces, palate, and tonsils become greatly swollen and 
covered with coagulable lymph, the nasal mucous membrane, 
parotid and other glands severely implicated, swollen, and often 
suppurating. Sometimes there is a diffuse inflammation of cel- 
lular tissue of the neck, which is swollen and of a brawny hard- 
ness. The eruption may be delayed to the third or fourth day, 
and may then come out in scattered patches. With its fading, 
on the fifth or sixth day, the fever as well as the inflammation 
of the throat begins to abate. Severe inflammation of the serous 
and mucous membrane is to be dreaded. In strenuous subjects 
it often assumes quite an aggravated form. Cases sometimes 
occur in which there is no eruption on the skin at all, and still 
it peels off after recovery. 

In Malignant Scariet Fever it assumes a malignant or 
typhoid form. Great cerebral disturbance, convulsions, urgent 
prostration, muttering delirium, sordes on teeth, foetid breath, 
incrustations of coagulable lymph on tongue, uvula, tonsils, 
fauces, gangrene often takes place, and there is suppuration of 
throat, nose, ears, and eyes. The rash, if any, is purple or livid ; 
if it comes out it is late ; more generally it never appears. A 
fatal termination almost invariably takes place on the third or 
fourth day ; few indeed weather the storm. 

Terminations. — Very apt in anginosa to terminate in ulcer- 
ation and enlargement of the tonsils, inflammation of eyes and 



122 ERUPTIVE FEVERS. 

ears and glands of the throat, with suppuration. Acute rheu- 
matism, inflammation of heart, vaginitis, dropsy of the serous 
membranes, and acute desquamative nephritis, with albumin- 
uria, Ursemia is to be feared in mild cases as well as severe. 

The scarlatinal germ makes great havoc with the red cor- 
puscles of the blood, and the patient, unless well cared for, is 
liable to suffer permanently in health, and become affected 
with a variety of diseases dependent upon a deteriorated state 
of the nervous system as well as the blood. The remedies 
hitherto used by some members of the medical profession have 
been highly deleterious, and not prejudicial to the destruction 
of a livinggerm in the blood, nor maintain ance of vital force. 

The contagion of scarlatina is very powerful, a fact that can- 
not too strongly be impressed upon nurses, parents, and teachers. 
Parents are unaware that their little child, who has just recov- 
ered from an attack of scarlet fever, is able for at least three 
months to disseminate the disease wherever he goes, — that 
there is enough of living disease-producing bioplasm left on 
his hair and damaged cuticle to communicate the disease to at 
least a quarter of a million of other children, so that besides a 
complete change in the treatment after recovery there should 
be established a strict quarantine for at least that period of time, 
by which time, we have reason to hope, all contagious particles 
will have died out. 

The time looks long, but we must look at the dangers that 
ought to be avoided. 

Prevention. — Contagious and infectious diseases like scarla- 
tina, small-pox, and typhoid fever, can be prevented or rendered 
so mild that the affected individual will not require to go to 
bed. On the first appearance of those diseases, the most rigid 
measures should be adopted to prevent them spreading, either 
in the family, school, or neighborhood. For this purpose it 
should be borne in mind that good diet, daily bathing, cleanli- 
ness, avoidance of all excesses, and removal of insanitary states, 
and every one in close contact deemed susceptible of the disease 
should be placed upon antiseptics, for it is a well-known fact 
that when the body is charged with those it affords a most un- 
favorable nidus or field for any disease-germ to grow, and their 
multiplication is at once prevented. Accordingly, when the 
disease is suspected, begin at once with antiseptics (even if 
late), and hold on to them, for if too late to prevent they will 
render it so mild that it will scarcely amount to much, — they 
will arrest the germ-development in the blood during the incu- 
bative period. What drug shall be given? We say any one that 
will not irritate the stomach, that is very soluble, and that will 
enable the body to resist decomposition, such as sulphurous 
acid, chlorate or permanganate of potash, iodine, carbolic acid, 



ERUPTIVE FEVERS. 123 

arsenic. The following is an excellent formula, and one readily 
taken by children, and perfectly arrests germ-growth and de- 
stroys an}^ already formed. Take eight ounces of the syrup of 
poppies; one ounce and a half of sulphurous acid; two drachms 
of Fowler's solution. Mix. One tablespoonful every three hours 
to a child from five to ten years of age, continued for ten days 
or more. 

If this is not thought well of, then the carbolic acid and tinc- 
ture of iodine prescription, as laid down under typhoid fever, 
should be used. The same method should be adopted in small- 
pox, although there I have been most successful with solution 
of chloride of lime, which acts so well that the pox never form 
at all. 

Treatment. — In the general management of a case, the ordi- 
nary precautions for fever must be observed — rest in bed, 
warm comfortable room, sponging thrice daily till eruption ap- 
pears ; diet, beef-tea, milk, and lime-water ; antiseptics in the 
apartment ; silk or fine articles of clothing next to the patient's 
body ; bowels and kidneys looked after. 

. As a cool and refreshing drink all through the fever, give the 
following: Take a heaped teaspoonful of tartrate of soda and 
add to seven ounces of water, flavor with essence of lemon, and 
as soon as the salt is dissolved add gradually a little lemon- 
juice till effervescence ceases. The patient may be allowed this 
freely, as it destroys the germ and keeps moisture on the skin. 

The febrile action must be controlled by sufficient doses of 
tincture of aconite, belladonna, digitalis, and compound tinc- 
ture of serpentaria. One teaspoonful of each to four ounces or 
half a tumblerful of water. A teaspoonful every two hours, or 
more frequent, to keep down heat, pulse, and respirations. A 
piece of raw tenderloin beefsteak, or some other fresh animal 
matter, to the throat, reaching from ear to ear, changed thrice 
daily, or vaseline or ozone ointment, to attract and destroy the 
germs. Chlorate of potash and muriatic acid, two drachms of 
each to four ounces of water. One teaspoonful three times a 
day in sweetened water, so as to evolve the chlorine, which is so 
destructive to germs. As a tonic all through the case aromatic 
sulphuric acid and quinine, one ounce of the former to twenty 
grains of the latter, the dose depending upon the age of the 
child. Young children of two or three years, five drops in water 
three times a day, which, with the chlorate of potash mixture, 
should be continued several weeks after recovery. Sulphur, 
the flowers, half a teaspoonful added to a little water, and 
gargle the mouth and throat at least thrice daily. As soon as 
the rash makes its appearance, discontinue the bathing, and 
instead anoint the body three times a day with warm olive oil, 
or, if expense is no object, vaseline or ozone ointment, which is 



124 ERUPTIVE FEVERS. 

the best of all applications, as the latter destroys the germ on 
the skin. Those applications have a good effect besides the de- 
struction of the germ, — they attract germinal matter to the 
surface; they allay the burning and tingling, and thus diminish 
reflex irritation; they obviate desquamation or peeling, thus en- 
abling the patient to get among his fellows much sooner. The 
above is simple and efficacious treatment — aconite soothes the 
irritated nervous system ; belladonna paralyzes the nerves of the 
throat, and maintains the fluidity of blood ; digitalis protects 
the kidneys ; serpentaria gives the germs a determination to 
the skin ; the chlorine and sulphur destroys the living germ in 
the blood. If eruption does not strike out well, increase the 
serpentaria and give in warm sweet marjoram tea. Avoid iron 
and ammonia as poisons; they retard the action of the kidneys 
and are productive of dropsy. 

In very bad cases ozone water could be substituted instead 
of the chlorate of potash. In the malignant form no treatment 
is of much avail, still we would give the above a fair trial. 
Well it is that it is rare. Some medical men have a tendency 
to represent the type of disease in an aggravated form, calling 
anginosa malignant; whereas without great prostration, a livid 
or purple rash, and suppuration from the eyes, nose, and ears, 
it should not be so designated. 

The most common sequelae is dropsy, a serous infiltration of 
the cellular tissue, dropsy of the three great cavities, sometimes 
labia and scrotum. This may be due to cold, the function of 
skin arrested, and the force of the insensible perspiration thrown 
on the kidneys, producing congestion and obstruction. The 
true cause is a blocking up of the structure of the kidneys by 
the germs, and it is a notorious fact that it is rarely present 
when digitalis is given, while it is the invariable sequelae when 
iron, ammonia, and brandy are administered, — these three 
agents seem to arrest the urea in the weakened kidneys, and 
thus give rise to the difficulty. Under the old empirical treat- 
ment dropsy came on early, being ushered in with chilliness, 
headache, fever, and often vomiting. Face anaemic and puffy; 
general oedema, urine scanty, high-colored, dark smoky appear- 
ance, and contains albumen in large quantities. 

In the treatment, great care and nice discrimination must be 
used. Infusion of digitalis, parsley-root, and asparagus are very 
useful, aided with warm baths and flannel, same as for effusion 
of serum and dropsy. Keep bowels rather free, and in all cases, 
irrespective of condition, an infusion of haircap moss should 
be prescribed and persistently administered. This has an ex- 
cellent effect, being gentle, efficient, ever trustworthy, and seems 
to brace up the weakened kidneys to active work. Continue 
tonics for two or three months, with good food. 



ERUPTIVE FEVERS. 125 

SMALL-POX. 

Of all forms of degraded bioplasm of our own bodies, variola 
is the most loathsome, pungent, and contagious. It is the most 
perfect and definite of all disease-germs. 

There is no safeguard against it, except in a high standard 
of health, for vaccination is neither protective nor prophylactic, 
but a delusion, a superstition, or mental hallucination. The 
inoculation of the cow-pock on the human subject is one of 
the most despicable and diabolical acts with which the medical 
profession have cursed mankind. Two-thirds of all our do- 
mestic animals are diseased, suffering from anthrax, plague, 
typhoid pneumonia, foot disease, which is analogous to diph- 
theria, and nearly all are tubercular. This infamous wrong, 
this scientific delusion of the perpetrators of this criminal out- 
rage, is based upon the idea that the introduction of the cow- 
pock germ into the human blood will eat up all the pabulum 
upon which the variola germ could subsist, and that if the in- 
oculated individual were subjected to the contagium vivium of 
small-pox that he could not take it, because there were no ele- 
ments upon which it could subsist in his blood, so he was pro- 
tected. It is the greatest farce in the whole domain of medicine. 
Practical experience has demonstrated it to be a fallacy, that 
it is no protection, that it does not even render an attack milder, 
but rather implants the diseases of the animal in the human 
being — degrades man's divine nature, and is inimical to the 
very existence of our race. 

To corroborate this the Register-General of Great Britain, in 
his report of 1880, states, with the greatest accuracy, that the 
death-rate from small-pox in London in 1860 was seven per 
cent.; in 1870, seven and one-half per cent; and in 1880, under 
compulsory vaccination, it ran up to fifteen and one-half per 
cent. This is the healthiest city in the world, and under the 
most despotic form of compulsory vaccination. This exhibits 
no stamping out, but a fearful increase, in spite of this filthy 
practice. 

Small-pox may be defined to be a continued infectious fever, 
attended with an eruption of papulae or pox, due to the degra- 
dation of the living matter of our own bodies — a specific living 
poison, communicated by contagion and infection. Particles 
of the germ variola are so light that they can be carried in 
the air for great distances — thousands of miles away from the 
diseased organism — and find their way into the blood by the 
mouth, bronchi, &c. 

Like all other diseased germs their virulence is increased in 
fluids, as water, and the body after death forever contaminates 
the earth, for nothing but cremation insures their destruction. 



126 ERUPTIVE FEVERS. 

The germ in the human body has four stages of existence, — 
germination, twelve days; growth and seeding, three days; 
germ seeking oxygenation in colonies, papulae, or pox, complete 
on ninth day; colonies or scabs fall off in from fourteen to 
twenty-two days. 

Symptoms. — The period of germination in the blood, or 
latency, or incubation, lasts twelve days, during which time 
there is languor, lassitude, debility, pain in the head, in the 
loins, and calves of the legs, with persistent nausea and vomit- 
ing, tongue not much coated and white of eye clear, and as 
early as the ninth day a gritty feel can be detected in the skin. 
Following these symptoms a rigor and fever of three days, dur- 
ing which time pains in the head, loins, and muscles continue, 
but nausea and vomiting usually cease. When vomiting is 
severe, pains in the loins intense, they may be regarded as pre- 
cursors of a bad attack. Peculiar eruption of pimples or papu- 
lae appear at the end of the third clay of fever, appearing in the 
following order: first on the face, then on the neck and wrists; 
secondly, on the trunk, and lastly, on the lower extremities. 
The papulae have first a hard, shotty feel, then present vesicles 
on the summit, which gradually expand laterally to about the 
diameter of a split pea, are flat or depressed in the centre. On 
the eighth day of the eruption an inflammatory areola or circle 
forms around the vesicles, and their contents become cloudy 
and then purulent, the vesicles gradually ripen into pustules, 
suppuration being complete on the ninth day, at which time 
finer pustules break and crusts or scabs form. In from five to 
nine days more, longer or shorter, these scabs fall off. 

In many instances the rash on the skin is accompanied with 
a similar one on the mucous membrane of the nose, mouth, 
throat, eyes, and ears; in others by a swelling and inflammation 
of the subjacent areolar tissue; occasionally by marked irrita- 
tion of the nervous system, delirium, and convulsions. 

The severity of the disease usually bears a direct relation to 
quantity of eruption. When pustules are few, and they remain 
distinct and separate from each other, the disease is not severe ; 
when very numerous, they run together, coalesce, and lose 
their regularly circumscribed circular form, it is highly dan- 
gerous. This has caused a division of small-pox into variola 
discreta and variola confluent. Former not near so dangerous 
as the latter. Eruption on the face may be confluent, while 
scanty over the body; still if so, the disease is regarded of the 
confluent kind. Sometimes the pustules are so numerous that 
they touch each other, but do not coalesce ; it is then said to be 
the semi-confluent form. Sometimes they are grouped in circles 
or clusters, and the name Corymbose applied. If in either case 
symptoms of malignancy or putrescency are added, the disease 



ERUPTIVE FEVERS. 127 

is termed malignant small-pox, a most formidable affection. 
Occasionally after the early symptoms, as pain in the loins, 
nausea, vomiting, a rubeoloid or measley eruption, and later 
minute petechia, which increase in number and size, haemor- 
rhage takes place into the conjunctiva and from the bladder, 
bowels, (fee, and death occurs on the fourth or sixth day; no 
characteristic rash, only a few scattered papules or vesicles 
having appeared, it is called hsemorrhagic small-pox, which is 
almost invariably fatal. 

The greatest difference between the distinct and confluent 
form exists from the beginning. All the symptoms in the con- 
fluent form are very aggravated, intense, often proving fatal 
from the blood being surcharged with a living destructive 
poison. During its course, troublesome complications are likely 
to arise, as erysipelas, swelling of the glands in the groin and 
axillae, phlebitis, ichorheemia, glossitis, plurisy, pneumonia, 
ulceration through the cornea, and suppuration of eyes and ears. 
No contagion so potent as the living germ of small-pox ; infec- 
tion lasts all through the case, from the earliest symptom to a 
little after the last crust has fallen off. One attack exhausts 
the susceptibility of the system to future attacks, as a rule. The 
practice of inoculation with the variolous matter is illegal, 

Small-pox is easily recognized by the history of the case, the 
period of incubation, fever, and rash ; in the earliest stage by pain 
in loins, nausea, vomiting, and a white or clear conjunctiva. 

Treatment. — Much depends upon the recognition of the 
disease early ; true, we cannot quite break it up, but it can be 
mitigated and rendered very mild. This can be done during 
the twelve days prior to the fever in the following manner : A 
daily emetic of lobelia, preceded and followed by drinking 
freely of an infusion of pitcher plant and composition powder, 
in which there is ten grains of sulphite of soda dissolved ; this 
should be immediately followed with a dose of epsom salts, to 
which has been added fifteen drops of aromatic sulphuric acid, 
followed by an alcoholic vapor bath, to which half an ounce 
of tincture of iodine is added. Then keep the patient in bed, 
put a plaster of capsicum and vinegar, or else mustard, over 
the region of the stomach, and give carefully, and in small 
doses, one of the following antiseptics, to destroy the germ in 
the blood if possible; only one to be selected: 

Sulphurous or aromatic sulphuric acicl, about a drachm, 
added to a tumbler of water; a teaspoonful to be given at inter- 
vals, as the stomach will tolerate it. 

Sulphite of soda, thirty grains, as above. 

Permanganate potash, four grains, as above. 

Chlorate of potash and muriatic acicl, fifteen grains of the 
former to fifteen drops of the latter, as above. 



J 28 EKUPTIVE FEVERS. 

Iodine and carbolic acid, same as in typhoid fever. 

Salicylate of soda, a powerful antiseptic, is probably best 
adapted for the febrile stage. 

Ozone water. is very destructive to the germ; and the best, 
most efficacious of all, is chloride of lime, made as follows: 

Take two ounces of carbonate of lime, and saturate with two 
drachms of muriatic acid, to which add six ounces of water. 
Filter well, and administer in teaspoonful-doses every three 
hours in water. 

This antiseptic plan is to be carried out very rigidly during 
the stage of incubation, and also during the three days of fever, 
and in another form during the balance of the disease. 

When the rigor takes place and fever sets in, it is likely to 
be very mild if the antiseptic plan has been carried out. After 
the rigor the patient must be kept in bed, in a well-ventilated 
room, free from carpets and curtains, and disinfectants freely 
distributed around the apartment. After his long fast the 
patient oftenhas a keen appetite, and the diet should be gener- 
ous — arrowroot, beef essence, milk, and lime-water, ripe fruits, 
warm drinks. Sponging the entire body during the three days 
of fever with warm mustard water and soda must not be ne- 
glected; after rash appears it must be discontinued. All through 
an attack of small-pox, from its incipiency to its termination, no cold 
article of food or drink, such as iced drinks, cream, or ice, should be 
given or applied to the patient. 

Arterial sedatives, as tincture of aconite, veratrum, and bel- 
ladonna, one teaspoonful of each to half a tumbler of water, of 
which a teaspoonful should be given every hour or two. 

Aromatic sulphuric acid and quinine — one ounce of the for- 
mer to thirty grains of the latter — fifteen drops of the combi- 
nation every four hours. 

During the febrile stage the salicylate of soda, being not only 
an efficacious antiseptic but powerful arterial sedative, should 
be given. If its use is contra-indicated, give some of the other 
antiseptics. Warm drinks, as infusion of pitcher plant freely, 
with the addition of a few grains of bicarbonate of potash, change 
of sheets and linen daily, bowels open daily with enemata or 
salines. At the end of the third day eruption appears. Keep 
on with treatment, increase the quinine mixture; antiseptics 
need not now be pushed, still not discontinue if pocks do not 
fill well; nourishment and stimulants are demanded, — for a 
few days, fifteen-drop closes of tincture of black cohosh, thrice 
daily, has a marked effect in filling the pocks. When the erup- 
tion is out, anoint the face, eyes, nose, mouth, and ears freely 
with vaseline or ozone ointment — it will effectually prevent 
pitting. Cover the face and hands with a mask. Repeat twice 
or thrice daily. 



ERUPTIVE FEVERS. 129 

Much has been said of the virtues or antidotal properties of 
the pitcher plant in small-pox, but the experience of the entire 
profession must be taken as a criterion of its worth. The opin- 
ion of its value is, that it has no power whatever in the destruction 
of the germ ; nevertheless it is a peculiar diaphoretic, acting 
chiefly upon the follicles of the skin, rousing them into activiy ; 
besides, it is slightly depurative, and as the small-pox germ is 
a great scavenger to diseased blood, eating up the germs of 
tubercle, syphilis, and cancer, if they be present, the pitcher 
plant aids its action in some mysterious way, and in spite of 
the fact that in itself it is of little utility, and never can rank 
with an antiseptic, we still would say give it in a decoction all 
through the case. No other preparation than an infusion is of 
any value. It may be drank freely. 

Yellow light seems to be most prejudicial to the germ when 
it appears upon the skin ; not so inimical as darkness, however; 
though under either state no pitting takes place. 

Tincture of iodine exposed in saucers throughout the bed- 
room of the patient, and some other disinfectants in any nook 
or corner of the dwelling, should, in all cases, be very rigidly 
enforced, as they are of great efficacy in destroying disease 
germs, and thus preventing their exit from the dwelling. 

The factor in small-pox is the germ, and the whole aim and 
object of treatment is its destruction, and the maintainance of 
a high state of vital power to resist its destructive influence in 
the blood, so that the more antiseptics we can crowd in with- 
out offending the stomach, the milder the case. Indeed, so 
certain is this, that if we only see it early, a fine papulae, or 
more frequently none at all, is the result of the above method. 
All complications must be treated on general principles; delir- 
ium and convulsions with belladonna and bromide of potash, 
heat to feet ; restlessness by hop pillows or anodynes. If boils 
or abscesses form, open and poultice with yeast and flaxseed. If 
mucous membrane of throat is seriously implicated gargles of 
boracic acid, sage tea and glycerine should be used. 

The above treatment effectually prevents pitting; vaseline or 
ozone ointment is unexcelled ; but, as we have remarked, wear a 
mask till you have faith in the action of the remedies. We can- 
not insist too strongly on the imperative necessity of persistent 
and careful nutrition all through the case, — food often, at proper 
intervals by day and night. Beef-tea, broths, milk food, cream, 
finely chopped meat, chicken, game, are most acceptable. 

The retrograding action of alcohol on all disease-germs must 
not be overlooked ; this property alone renders it an agent of 
infinite value in the form of milk punch. There is no form of 
fever that bears such an amount of careful nutrition in all 
forms as small-pox. 



130 DISEASES OF THE BLOOD. 



DISEASES OF THE BLOOD. 



SCROFULA, TUBERCULOSIS, STRUMA. 

Synonymous terms used to designate a diathesis or cachexia 
in which the living disease-germ tubercle exists in the blood. 
The disease-germ tubercle is a change, an alteration, or degra- 
dation of the normal living matter of our own bodies. The 
precise method of degradation is unknown, but it originates 
within the body, and if man is not responsible for its origin, he 
has certainly himself imposed the conditions favorable for its 
production and dissemination. 

The primary cause is some inherent defect or depreciation 
of the nerve centres — of that portion that presides over organic 
life and elaboration of blood causing a degradation of bioplasts 
into a disease-germ, which has new and independent power of 
existence, reproduction, and endless multiplication in human 
blood. 

The causes that bring about this defect or deterioration of 
the human race are very varied — such as incompatibility of 
race, temperament, and age; the use of alcohol and tobacco; 
vaccination, isolation, monotony or sameness ; demoralizing liter- 
ature, immorality, vice ; deleterious trades, as factory labor, lead, 
mercury, and phosphorus operatives; masturbation, drastic 
drugs; meagre, unwholesome, or insufficient food; insanitary 
surroundings, contaminated water, irritation reflected, absence 
of sunlight, drinking snow or ice water, disease, immoral atmos- 
phere, reflex emanation, city life, water charged with sewerage. 
Observation and experience confirm the fact that children, 
the product of two distinct, opposite, antagonistic races, are 
all tubercular ; persons identical in temperament, same in 
all physical and mental traits, are really consanguineous, and 
their marriage is equivalent to in and in breeding — progeny, 
tubercular children ; the offspring of very old men are tubercular. 
In a series of observations of five hundred brains of drunkards, 
tobacco users, monotonous or isolated individuals, there was dis- 
tinctly noted a general coalescence of the typical fissures, — a 
condition present in hereditary insanity, epilepsy, idiocy, and 
other low types of the human brain, — the offspring of such are 
all tubercular, of a brain type; vaccination may convey the 
tubercular germ direct from the heifer, as two-thirds of all our 



DISEASES OF THE BLOOD. 131 

domestic animals are diseased; even if lymph is pure, the practice 
deteriorates. It is unnecessary to point out the vitalizing ac- 
tion of morality and the depreciating effects of vice, immorality, 
and bad literature, in the production of a lower stratum of 
vitality, tubercular. The absence of sunlight, the drinking of ice 
water, insanitary surroundings, and other defects of modern 
civilization, have a decided action in whittling clown vital force. 
The children of all operatives in lead, mercury, phosphorus, 
tobacco, cotton, and woolen factories are tubercular. The loss 
of important secretions, as in masturbation, render all the out- 
comes tubercular. Irritation reflected is a common cause, teeth- 
ing, worms, and later in life causes not so numerous. As to its 
being contagious and infectious, the fact is indisputable and 
requires no illustration. Every thing that has a lowering, de- 
preciating action on human life may be enumerated as a cause. 

AVhen the constitutional defect is once acquired it may be 
transmitted to the children. Besides being hereditary and 
acquired it is, like all germ diseases, contagious and infectious. 
There can be no doubt that tubercle is often acquired by inha- 
lation of the germ from affected persons through the atmos- 
phere. The breath of infected persons is heavily loaded with 
the germs, — and the nocuity or inocuity of that breath will 
depend much on the suitability of the soil, as weak vital force, 
damage to lungs, &o, of individuals who are in close prox- 
imity, and explains the remarkable immensity to the diseases 
of persons in health. As it is supposed a very large per cent, 
of our domestic animals are also tubercular, man gives and 
receives this living contagion from them, by their breath, 
exhalations, milk, and flesh. Some estimate the percentage of 
tubercle in our animals to equal that of man about seventy-five 
per cent. 

A man or woman's blood may be fairly loaded with this 
germ, and vital force very feeble, and unless there is some local 
weakness, the germ growth may not be apparent; but let there 
be a partial death of some organ, tissue, gland, or structure, 
the germ will readily find its way through the walls of vessels 
and grow with prodigious activity in the weakened part, In 
this manner germs find their way on the membranes and sur- 
face of the brain of little children, who have received blows, 
falls, and other shocks, to the giving tubercular meningitis; lesions 
of joints, coxalgia, white swelling ; an inherent weakness in bones 
from starchy food and absence of phosphates, rickets; feeble 
lung structure, pulmonary consumption ; weakness in bowels and 
mesentery, tabes mesenterica. Although this diathesis is so very 
common a fact that it can be transmitted from parent to child, 
and that it is so thoroughly blended through society, still it 
does not, in the true sense of the term, establish a morbid race, 



132 DISEASES OF THE BLOOD. 

for that is an utter impossibility, the evil curing itself by non- 
procreation. The very great prevalence of this cachexia among 
the best fed, housed, and clothed people in the world, excites 
the attention of all lovers of his race. 

Symptoms. — Debility and indigestion are leading symp- 
toms, torpid liver, defective pancreatic secretion, paleness and 
whiteness of skin, intellectual system often well developed, 
but incapable of long efforts; puffiness of face, with swelling of 
lips and nostrils; purulent discharges from ears; vesicular 
eruption about the head, enlargement of tonsils or glands of 
neck; often disagreeable odors from skin, especially from feet 
and axillae; feebleness with rapidity of pulse. The debility 
is progressive, so is the loss of weight. As vital force progresses 
downwards, tubercle takes a rapid growth, temperature rises. 
Signs of tubercular growth and effusion in the organ affected. 
It may set in at any period of life if the blood is charged with 
germs. General liability is when the system is least resistant 
to depression — from three to fifteen or from eighteen to thirty 
years of age. Its development and progress are favored by 
anything that can depress or depreciate vital force, and thus 
cause a blight. The part in which the germs are thrown out and 
grow must suffer local depression. 

When tubercle escapes from the blood through the walls of 
vessels that have lost their contractility, it appears under the 
microscope to consist of small round cells or cysts, imbedded in 
a cellulose membrane, and it can be seen growing like other 
germs by a proliferation from the walls of the nuclei. If the 
mother cell or cyst be squeezed lightly between two pieces of 
glass, so as to rupture it, in its contents can be detected millions 
of minute tubercles, — their mode of life, progress, death, or de- 
generation depending on their number, character of tissue, or 
structure in which they are effused, and the amount of partial 
death present in the part, — all influence or modify the progress 
and vitality of the germ. From the degraded cell or mother 
germ, the growth is by a budding or duplication, and when it 
dies, either from age, want of nutrition, or some adverse state, 
its albuminoid contents become first milky, then cheesy, then 
calcareous, and in any of these three stages it may break 
down and be thrown off or absorbed. Its color may be influ- 
enced by particles of coloring matter in the air or food. Its 
ultimate degeneration is phosphate of lime. 

To prevent the development and transmission of tuberculosis, 
no diseased person should be permitted to marry, and State en- 
actments should be made forbidding opposite races, or persons 
identical in temperament, from marrying. Great care taken of 
mothers, — no drain or strain on their physical and intellectual 
resources, especially during pregnancy or lactation. Strictest 



DISEASES OF THE BLOOD. 133 

attention paid to the infant's food, quality of milk, clothing, 
and air it breathes. Avoidance of all insanitary states, as bad 
ventilation, ill-drained or damp houses. No tubercular mother 
should be permitted to nurse her child. An avoidance of all 
that tends to deteriorate, as sexual excesses, bad food, or im- 
perfect digestion. The diet should be of the best and blood 
manufacturing; dress, exercise, repose, and association, should 
be looked after, — the function of skin and bowels to be aroused, 
the powers of digestion increased and everything done to in- 
crease brain vigor, correct faulty nutrition and promote the 
formation of healthy blood. 

As to the cure of tuberculosis, we would merely state, that 
all cases are curable before it has taken up a local habitation 
except those cases due to a mixture of races ; for these there is 
no hope, as no sanitary arrangement, no amount of bathing, 
no kind or quality of food, no climate either on sea or land, 
and no known drug or method of treatment that can stamp it 
out — it is indelible. To cure it, we must resort to every means 
of restoring or building up vital force and the germ must be 
annihilated in the blood, as no living disease-germ can be 
eliminated. 

Digestion, assimilation and secretion merit our first atten- 
tion. Daily bathing, using iodine freely in the water, temper- 
ature regulated by vital force of patient, followed by inunc- 
tion of a few ounces of olive oil into the body. Sleep should be 
prolonged to eight or nine hours, in harmony with the earth's 
magnetic law; head of bed to north, foot to south, insulated by 
glass castors; clothing woolen, a good non-conductor and vi- 
talizer. Diet varied, abundance of fresh, wholesome animal 
and vegetable food, embracing oatmeal, milk, cream, eggs, boiled 
fish, beef, mutton, poultry, game, with abundance of bread and 
butter. As to location, one where there is an abundance of 
fresh air, pure water, and no insanitary surroundings — free ven- 
tilation. Change is essential to a high grade of physical and 
mental vigor. The patient should be surrounded with a vital- 
izing, religious, and high moral atmosphere, and his reading, 
history or science. 

Medical agents to be used embrace two classes — one to 
strengthen, construct nerve power, restore lost vigor; the other 
to destroy a living disease-producing germ in the blood. The 
two classes of drugs should be administered alternately two or 
three hours apart, and changed weekly, as man becomes habit- 
uated to any one drug long continued, it becomes in a great 
measure inoperative. We will briefly enumerate the two classes : 

Our best tonics in tuberculaa are those that promote digestion, 
and facilitate the rapid evolution of red corpuscles, for which 
compound tincture of cinchona, four ounces; aromatic sul- 



134 DISEASES OF THE BLOOD. 

phuric acid, one ounce. Mix. One teaspoonful thrice daily in 
water, one hour before meals; operates well. Indeed all pre- 
parations of cinchona and mineral acids favor the manufactur- 
ing of red discs. 

Another and probably the second best remedy is the com- 
pound tincture of kurchicine, prepared from the bark of hol- 
arrhena antidygendinica. This is unquestionably a splendid 
drug for the purpose. One tablespoonful before meals. 

As a general rule, we do not derive much benefit from iron ; 
the liver is always sluggish, and it makes the patient feverish 
and irritable; still it may be tried; the best forms are those re- 
commended under anaemia, acetated and muriated tincture, 
iron by hydrogen. 

All our bitter tonics, such as golden seal, gentian, collinsonia, 
quassia, &c, are of little value, owing their medicinal property 
simply to their bitter qualities. 

For the purpose of destroying the disease-germ tubercle in 
the blood, some of the following should be selected : 

Glycerite of ozone, Nature's great scavenger of diseased blood, 
is our best remedy. 

Iodine is invaluable, either in tincture form, or iodide of 
starch, or potash. 

An elegant efficient formulae is the following: 

Tincture of iodine, one ounce; glycerine, six ounces; oil of 
eucalyptus, half an ounce. — Mix. A teaspoonful two hours after 
meals in sweetened water. 

Tincture of iodine, two drachms; carbolic acid, one drachm; 
tincture of nux vomica, half an ounce; muriatic acid, two 
drachms; oil of eucalyptus, two drachms; water distilled, fif- 
teen ounces. — Mix. One tablespoonful four times a day. 

In the above the oil of eucalyptus must be cut with half an 
ounce of alcohol and shaken ten minutes before it is added. 

The iodide of potash or soda is best given in the ozonized 
syrup of eucalyptus. Chlorine is extremely beneficial. Chlo- 
ride of potash or chlorate of potash, two drachms; muriatic 
acid, two drachms ; water, four ounces. — Mix. One teaspoon- 
ful three times a day in a glass of water, and just when ready 
to take add a small teaspoonful of sugar to evolve the chlorine 
on the stomach. 

Chloride of gold, platinum, and mercury, are destructive to 
the germ but as they are liable to produce other changes not 
desirable are not used. 

The hypophosphite of potash is of great utility, five-grain 
doses three times a day ; it not only destroys the germ in the 
blood, but is so penetrating in its action that it will annihilate 
it after being encysted in some gland, or organ, or tissue for 
years. 



DISEASES OF THE BLOOD. 135 

CARCINOMA. 

Cancer is a term applied to a diathesis in which the normal 
bioplasm of the blood is degraded or damaged, and a malig- 
nant bioplast or germ formed. It is essentially a germ disease, 
found in the blood of man and domestic animals, caused by some 
defect in the nerve centres. In many cases the blood is loaded 
with this germinal matter without the slightest local manifesta- 
tion of cancer. In order to obtain the latter when the cachexia 
is present it will be necessary that some part be weakened by a 
blow, an injury, or irritation, so that the walls of the blood- 
vessels of the part weakened by violence, may lose their tonicity 
or contractility, so as to enable the germ to pass through their 
coats or walls by exudation or exosmosis and find its way 
into the devitalized tissue where it forms a nest or colony. In 
this colony we find the diseased cancer-germ in one or other of 
two forms — the sarcomata, having a connective tissue, a type 
of structure small, round, or spindle-shaped cells, with no 
stroma but many vessels — the carcinomata consist of fibrous 
stroma with large cells of epithelial type in interstices, yield 
cancer juice in which the germs are readily seen — these two 
forms of colonization divide themselves into the following va- 
rieties or rather forms : 

Medullary, or soft, or brain cancer, (acute.) 

Scirrhous, or hard, or stone cancer, (chronic.) 

Epithelial, when skin and mucous membrane meet ; colloid 
gelatiniform, alveolar gum, &c. 

Melanotic or black cancer. 

Hsematoid, or fungus hsematodes, or rose cancer. 

Villous, lardaceous, osteoid, keloid. 

The causes that produce this change in the living matter of 
our own bodies are obscure ; we see it as a disease of civilization, 
being more prevalent in sections or localities noted for high 
mental culture, especially if the nervous system has been en- 
feebled by grief, anxiety, overwork. The peculiar or typical 
nervous defect may be hereditary or acquired, and when it 
once exists, whether of our own production or from the bodies 
of others, it is highly contagious and infectious. The causes of 
the peculiar innervation are very obscure, still there can be 
little doubt but that the various causes that operate in the pro- 
duction of tubercle, also have an analogous effect in the pro- 
duction of carcinoma. 

The change of normal cells into this malignant germ is 
usually attended with extreme languor, lassitude, debility, — 
strength and energy much impaired — the skin assumes a dirty 
yellow hue; the secretions are arrested — the conjunctiva of a 
pearly whiteness — features contracted, sinking feeling about 



136 DISEASES OF THE BLOOD. 

stomach — stools clay-colored ; great loss of strength and energy ; 
general wasting, with mental irritability. When the germ es- 
capes from the circulation and forms a colony, then we can 
detect a thickening, infiltration, induration, a separable tumor, 
which rapidly changes the structure of a part, usurps its original 
texture or organ — germs grow by millions, invade surround- 
ing parts, extend to nearest lymphatic and induce general 
germ poisoning. The very moment a malignant germ colonizes 
itself there is pain — a congregation of a few germs it resembles 
a needle — a larger aggregation, a knife — the smaller the colony 
the less the pain, and at long intervals; whereas in an immense 
collection the pain is not only like a large knife darting through 
the part, but it is frequent, almost continuous. If the cancerous 
infiltration occurs inside of the chest and abdomen, pain is both 
anterior and posterior, which is explained by the character of 
the spinal accessory nerves. 

It grows like all other living matter, and when from a de- 
ficient supply of nutriment or some other adverse condition, or 
natural death of the germ, disintegration and ulceration takes 
place, a foul, excavating ulcer, sanious, foetid discharge, the odor 
of hydrosulphate of ammonia, which the dead germ evolves, 
haemorrhages, progressive debility, anaemia, nausea, vomiting, 
diarrhoea, complete exhaustion, death. 

The tendency of all cases of carcinoma is to death, unless 
managed with great skill and long experience. 

Anatomical researches will undoubtedly soon throw new light 
on the origin of both cancer and tubercle. It is more than proba- 
ble that the true seat or origination of both will be found in or 
near the medulla oblongata and spinal cord, or some closely 
allied portion of the nervous system. 

In form, the disease-germ tubercle is round, and maintains 
this characteristic even in large masses or colonies, and under 
all stages of sprouting and growing, and is devoid of pain; 
whereas, the germ carcinoma is very variable in shape, being 
heart-shaped, spindle-shaped, oblong, &c, and always accompa- 
nied with pain. Just like tubercle, a person's blood may be 
literally swarming with cancer germs who yet may live along, 
although feeling miserable, provided there is no local depres- 
sion or irritation to cause their escape into relaxed tissue. The 
germ growth depends a good deal on the structure into which 
it is lodged. 

The cancer germ is most tenacious of vitality ; it can be pre- 
served alive for ages in damp cloths, in the ground, or in water. 

In the recognition of cancer we need not enumerate the men- 
tal irritability, the contracted features, the sallow skin, pearly 
appearance of conjunctiva, the odor of the breath, the sinking 
feeling about the stomach, the clay-colored stools, nor the dry, 



DISEASES OF THE BLOOD. 137 

husky skin. It is sufficient that we have a thickening indura- 
tion, or infiltration, or tumor, and in that there is pain of a 
sharp, lancinating character, with intervals between, and that 
it resembles a needle or knife; that if the cancer colony is in 
the chest or abdomen that there is pain anteriorly and posteri- 
orly — direct through ; that if the cancer is on the face, breast, 
or other exposed part, and is ulcerating or disintegrating, then 
there is soreness, rawness, gnawing, as well as the intermittent 
pain, and the smell or odor of the discharge is most significant. 
Besides, in the cancer-juice and urine the cancer germ can be 
seen with a very low power. AVe cannot well speak of diag- 
nosing such varieties as long as covered by skin. The medul- 
lary, or acute, or brain-form may be known by the intensity 
and frequency of pain; if covered, lobulated, doughy; if ex- 
posed, one mass of cancer germs; the hard, or stony feel of scir- 
rhus having an excess of fibrous tissue and a few cancer cells, 
and in the early stages little pain; the epithelial, or cancroid is 
easily known from its location, occuring where skin and mu- 
cous membrane meet; the black pigment matter of melanosis; 
the great excess of blood-vessels in fungous haematodes; the fatty 
feel of the lardaceous; the bony hardness of the ostoid ; the 
jelly or gelatinous material of colloid; the leathery patch on 
skin of keloid. As to the engorgement of the lymphatics, they 
simply afford us an indication of the state of the blood as re- 
gards germ growth — if heavily engorged, germs abundant and 
active; if slightly, germs few and inactive. 

The characteristics of cancer are definite, and different from 
all other growths or swellings, inasmuch as it is made up par- 
tially or wholely of malignant germs. There are a large num- 
ber of growths or tumors — some simple and others compound — 
made up of the healthy tissues of the body, as fat, cartilage, 
and bone, which, when occupying their proper places, are essen- 
tial to the perfection of the animal system ; but when misplaced 
may interfere with normal functions or locomotion it is indis- 
pensable to remove. But cancer has no counterpart in the 
healthy body; the very existence of its germs, or their locali- 
zation, sufficing to constitute disease; and more than that, their 
colonization in any part of the body is destructive, as they use 
up or convert healthy tissue into their own nutrition and 
growth. 

Cancer, although a large micro-organism, and quite weighty, 
nevertheless is contagious and infectious. It can be carried 
into a healthy organism by air, water, milk, or by contact, and 
may remain in the blood and tissues in a latent condition until 
favorable conditions exist for their growth. The cancer germ 
has wonderful capacity for resisting death, due to some inhe- 
rent power it possesses. We do not mean that it has the 



138 DISEASES OF THE BLOOD. 

vitality of the scarlatinal or small-pox germ, nor the remarka- 
ble power of dissemination and propagation. Germs differ 
widely in the facility with which they are propagated or spread 
from person to person. 

Treatment. — In the treatment we must bear in mind that 
we have to do with some great constitutional defect that gives 
rise to a degradation of the normal living matter of our own 
bodies with a malignant disease germ. No local affection, the 
latter being simply a colony of germs in some weakened part, 
so that our remedies should be directed to the primary cause, 
the destruction of the disease germ in the blood, as well as 
those concerned in the growth. 

We must give remedies to promote the activity of vital 
forces, increase their power, and at the same time destroy this 
disease germ in blood. 

We must inculcate daily bathing, with alkaline, iodine and 
nitro-muriatic acid baths ; nourishing food, vegetables, beef, 
mutton, poultry, game, milk, cream, raw eggs, oysters, boiled 
fish, and vegetable phosphates, as in corn and oatmeal ; flannel 
clothing ; moderate exercise in open air ; as much change of 
diet, habits, and location as possible consistent with comfort. 
The surroundings should be bracing and cheerful, mental 
occupation invigorating; secretions should be well regulated and 
the bowels open once a day with either phosphate of soda or 
white liquid physic, sleep to be extended to nine or more hours 
by conium, and other remedies, and appetite stimulated with 
compound tincture of cinchona, four ounces; nitro-muriatic 
acid two drachms. — Mix. One teaspoonful in water before 
meals. Then the patient should be placed upon either glycerine 
or ozone water in teaspoonful doses and the compound extract 
saxifraga ozonized, in tablespoonful doses, using the glycerine 
every two hours. Let the tumor or germ alone if skin is 
entire, simply keep it covered and moist with saturated solu- 
tion of chlorate of carbon, or Stramonium ointment or a solut- 
ion of sulphate of manganese. 

The clinical facts brought out by this method are interesting 
and instructive. The disease is arrested, the germ annihilated 
in the blood and the morbid growth does not increase in size. 
This applies to all forms or sub-varieties. After this is carried 
out usually about six weeks, the cancerous mass deports itself 
very much as if it were a foreign body, and seems disposed 
to make its way rapidly to the surface ; but although this takes 
place the growth shows no activity, for its bulk gradually 
diminishes in size. In other cases there is a decrease by exfoli- 
ation. From the first dose of the antiseptic there is amelior- 
ation of pain, and in a few days it ceases entirely. Lymphatics 
progressively diminish. On open cancer the effect is also good. 



DISEASES OF THE BLOOD. 139 

In large tumors, and cases where removal is indispensable 
either as a means of more rapid cure, or to satisfy the patient 
and his or her friends, then we must select a method devoid of 
pain as far as possible, and one that has the strongest affinity 
for the total destruction of cancer germs. We shall enumerate 
a few: the first is what we are at present using and supplying 
to the profession. 

Chloride of Chromium. — Make a saturated solution, dis- 
solve it so as to have quite a portion at bottom, then submit 
that solution for twenty-four hours to the action of ozone gas. 
After which hermetically seal and keep ready for use. When 
about to use, add a sufficient quantity of pulverized blood root 
and make into a paste of the consistency of molasses. When 
about to apply to a cancer protect the adjacent parts very care- 
fully with plaster, and then apply the plaster from half an 
inch or more thick with a wooden spatula. It will at once 
penetrate the entire cancerous tumor down to its most minute 
roots, cause either destruction of the entire germinal mass, 
give a perfect demarcation between the healthy and the 
morbid tissue and the process or application is not accom- 
panied with pain. Its ultimate removal is effected with 
poultices and ordinary dressing. 

The succus or expressed juice of the sheep sorrel, red clover 
tops and phytolacca root, evaporated down to the consistency of 
a heavy syrup spread on leather and applied, watching that no 
imflammation be excited; if there is, poultice and discontinue, 
when subsided reapply. Continue in this manner for several 
weeks till it drops out. It is tedious but not painful. 

The subsequent dressing is to be effected by antiseptic poult- 
ices, strapping with adhesive strips, and latterly ozone or 
vaseline ointment. 

During this process of removal, the constitutional treatment 
with glycerite of ozone and the ozonized compound extract of 
saxafraga is to be pursued. 

If the patient is irritable, or suffers in any way, relief must 
be given by hypodermic injection of a quarter of a grain of 
sulphate of morphia in solution at bedtime, with inhalation of 
a few drops of chloroform; this will give prolonged relief, or 
half of a grain of morphia may be given internally, or what is 
better is a pill of the extract of conium with one grain of 
pulverized opium, the quantity of conium to be as large as the 
patient can bear. 

To promote absorption, solutions of chlorate of carbon, 
sulphate of manganese, iodide of potass ; ozonized clay, or 
stramonium ointment. In the preparation of this ointment, 
it should be made with fresh lard, deprived of its salt, and the 
young tender leaves added as it is simmering ; those removed 



140 DISEASES OF THE BLOOD. 

as they become crispy, others added until the lard is thoroughly 
impregnated with it — greener in color than the plant leaves. 
This is much more prompt in its action than any ointment 
prepared from a solid extract. 

For all internal cancers, the application of the ozonized clay 
spread about from a quarter to half an inch thick, and strapped 
or bound carefully over the part, never causing redness of skin ; 
if so, let it remain off and reapply when it disappears. It might 
be taken off daily, moistened with water and reapplied; chang- 
ing the clay about once a week. 

For uterine cancers, the chloride of chromium is elegant, as 
it operates quickly, does not spread ; a pledget of cotton can be 
saturated or filled with it and applied. 

Constitutional treatment carried out. In the entire treatment 
let the idea be antiseptics; if it is vaginal or uterine, washes 
consisting of tepid water with permanganate of potash, sul- 
phate of manganese, lime-water, borax, as a wash for the 
ulcer. As to internal remedies, use alternately the following 
remedies for about a year: Alteratives two hours after meals, 
and to consist of ozonized saxifraga, compound syrup stil- 
lingia, iodide potash. Tonics before meals, and to consist of 
cinchona and mineral acids, aromatic sulphuric acid and qui- 
nine; conium and opium, two grains of conium to one of opium 
every three hours, so as to perfectly blunt the impressibility 
to pain. 

Other methods of removal accompanied with great pain some- 
times used for the removal or destruction of cancerous growths: 

(1.) Take equal parts of chloride of bromine, chloride of 
zinc, and chloride of antimony. Mix into a paste with pow- 
dered liquorice and apply. 

(2.) Blood-root pulverized, one ounce; chloride of zinc, two 
ounces; water, two ounces; flour, sufficient quantity- to make a 
paste. This is the form very generally used in the treatment 
of cancer; it is very painful, but never-failing, as a caustic, 
shriveling the cancer to a dried mass. 

(3.) Chloride of zinc, sixty grains; flour, one hundred and 
twenty grains; water sufficient to make a paste. Roll into 
sticks, dry and keep ready for use. Make incisions round 
tumor and insert. 

(4.) Take two or more ounces of C. P. sulphuric acid and 
saturate it with pulverized sulphate of zinc. Take a pen and 
dip in it, and go round and round the cancer several times, 
make a furrow, which fill with the paste; renew every few 
days so as not to excite much inflammation. Very useful for 
removal of cancerous tumors of the breast. A sniff of chlo- 
loform and a hypodermic injection at each application will 
relieve the pain. 



DISEASES OF THE BLOOD. 141 

SYPHILIS. 

Wherever sexual intercourse is loose and varied, few women 
among many men, there takes place a change, alteration or 
degradation of the normal living matter concerned in the 
nutrition of the organs of generation into a diseased germ — the 
syphilitic. This change in living matter is simply the result 
of a violation of divine and natural law. This degradation 
of bioplasm may result in an immature germ, its development 
up to a certain point and no further, or a perfect germ. This 
division has led to a description of it under two different 
heads: the imperfectly developed germ, producing a non-infect- 
ing inflammation of mucous membrane and skin ; whereas the 
perfectly formed germ produces constitutional contamination 
whenever applied, — in other words, the immature germ does 
not enter the blood, whereas the true perfect germ enters the 
blood and grows there. - 

The immature or imperfectly developed germ is capable of 
forming a specific form of inflammation of the urethra, and a 
soft non-infecting chancre or pock on the skin, provided there 
be a crack, fissure or abrasion by which it can reach the true 
skin — the germ present in the urethra or pock not having 
strength enough to enter the blood. Indeed, they are so im- 
mature as to be incapable of growth in that fluid, and if not 
interfered with will gradually die out in a few weeks ; whereas 
the mature, perfectly developed germ in the urethra, as an 
ulcer on the skin, as a chancre or sore will enter the blood, 
and if vital force is good it may remain latent ; vital force aver- 
age it will grow; vigor very feeble it grows with tremendous 
rapidity. 

As the venereal disease has been described as existing in 
primary, secondary and tertiary stages or conditions, it is now 
indispensable, under new light, to discard such terms applied 
to supposed stages in syphilis, because it does not really exist, 
for the living syphilitic germ can be communicated by con- 
tagion and infection in or during any supposed stage, and 
under all possible conditions; by breath, sweat, saliva, kissing, 
close contact; through air, water, milk, beef, clothing, beds, 
cushions, articles handled in ordinary use, and can be com- 
municated by parent to child ; no primary, secondary or ter- 
tiary condition being necessary. It needs no such process. 
Let it once enter the blood, it will grow and multiply with a 
slowness or rapidity according to the vital force of the indi- 
vidual. If health is feeble it will grow immensely, and while 
thus multiplying will find its way into weakened parts of the 
body, and thus give rise to an innumerable train of special 
affections, as skin, bone, mucous membrane diseases, epilepsy, 
asthma, etc., etc. 



/ 

142 DISEASES OF THE BLOOD. 

Although the immature germ, present in a soft non-infecting 
chancre, has not vigor to enter the blood, and even if placed 
there would die, it nevertheless has many complications or ac- 
cidents, such as sloughing or phagedena, and it may be asso- 
ciated with tubercular and other germs. We will briefly 
notice the disease first as a gonorrhoea, and then as a pock, 
simply to facilitate description and treatment. 

Gonorrhoea. — Inflammation of the mucous membrane of 
the urethra of the male or the vagina of the female, attended 
with a contagious muco or muco-purulent discharge, of which 
there are two varieties: first, that due to the immature germ; 
second, that due to the perfect germ. Usually about the third 
day of exposure to contagion, the or dinar} 7 symptoms of in- 
flammation make their appearance, — itching, pain, heat, red- 
ness, swelling with a slight milky discharge which soon 
becomes muco-purulent and profuse, great scalding, pain in 
groin, irritation of bladder, weight and dragging about the 
loins. 

The above embraces the general symptoms of the non- 
infecting form ; in the other or infecting form there are few, if 
any of the above symptoms present, but simply a muco-puru- 
lent discharge in the morning. 

In the non-infecting form the entire mucous membrane is 
affected, whereas, in the infecting, there is usually simply an 
ulcer or chancre in the under surface of the urethra. 

We have many and numerous complications in the male, as 
painful erections or chord ee, balanitis, hemorrhage from urethra, 
retention of urine, abscess, prostatitis, cystitis, orchitis, gonor- 
rheal ophthalmia and rheumatism. 

Treatment. — Mild saline aperients, moderate rest, diet free 
from articles that engender acidity, and if seen early- it is a 
good plan to abort it by washing out the urethra several times 
a day with borax and water, and after each ablution to inject 
it with : 

Distillation from eucalyptus leaves, four ounces; acetate of 
zinc, ten grains ; acetate of morphia, six grains. — Mix. 

Use after each borax injection any antiseptic lotion, such as 
borax, permanganate, chloride of zinc ; and internally adminis- 
ter compound syrup eucalyptus, four ounces ; balsam copaiba, 
one ounce. — Mix. From one to two teaspoonsful three times 
a day. 

For the Relief of Scalding. — Warm baths, sweet spirits of 
nitre in flaxseed tea. 

For the Relief of Chordee. — Half teaspoonful doses of 
green-root tincture of gelseminum at bed-time, to be repeated if 
necessary, and if it fails give twenty grains of bromide of pot- 
ash and repeat. 



DISEASES OF THE BLOOD. 143 

For Retention of Urine. — The same, with suppository of 
belladonna. 

For Hemorrhage. — Cold applications and gelseminum. 

For Balanitis. — Washes of permanganate followed by vase- 
line or ozone ointment. 

Chronic Gonorrhoea or Gleet. — A transparent mucous dis- 
charge, no scalding or pain, frequent calls to urinate, when the 
prostate or neck of bladder is irritable pain in perineum. 

Care should be observed in all cases of gleet that there be no 
stricture or thickening of the urethra, or weakness of the ejacu- 
latory ducts, or chronic inflammation of the prostate. 

Gleet free from these complications is easily got rid of by the 
administration of iron or cinchona, general tonics, injecting 
the urethra with cold water and an abundance of nourishing 
food. 

Gonorrhoea in the female is easily managed with copious 
vaginal injections of tepid borax water alternately with per- 
manganate at least thrice daily, with hot baths, and the same 
remedies internally as the male. 

That form of gonorrhoea dependent upon the germ of high 
power must be treated with antiseptic injections and other 
remedies in infecting chancre or constitutional syphilis. 

Soft, Non-Infecting Chancre is a local disease-germ too 
feeble to enter the blood, but gives rise to suppurative inflam- 
mation. There are usually several sores, with well-defined 
edges, looking as if portions of healthy tissue had been punched 
out. The secretion abundant. In the treatment avoid caustics, 
if possible, washing the sores thrice daily with a strong wash 
of permanganate, or sulphurous acid, or compound lime-water, 
or any other antiseptic ; and at other times keep them thickly 
covered with vaseline or ozone ointment. The method of treat- 
ment obviates the complication of suppurating bubo, which is 
so common after cauterization. 

This form of chancre in persons loaded with tubercular 
germs often takes on a peculiar appearance resembling a horse- 
shoe, losing its ulcerative tendency, and has a disposition to 
remain in statu quo for months. It is called serpiginous or 
dual germ, which nothing but iodine seems to destroy; so we 
give this internally and apply locally with the best results. 
Mix two drachms of iodide of potass, with half an ounce of 
tincture of iodine, and give from ten to fifteen drops three 
times a day. Paint the chancre once a week with the same, 
and apply ozone ointment in the interval. 

The non-infecting sore has a great tendency to suffer ad- 
ditional degradation by adverse conditions, and we often have 
the oidium albicans operating on it. Over-crowding, filth, 
prostitution, meagre or unhealthy food, with bad sanitary 



144 DISEASES OF THE BLOOD. 

conditions, aid in its production; then the sore sloughs, eats 
and takes on a gangrenous condition. 

Fresh air, nourishing food, great cleanliness, thorough hy- 
giene, removal of nuisances, antiseptic fermentations, hot 
hip baths, with permanganate of potassa or sulphurous acid ; 
poultices of yeast with salicylate of soda and opium, and give 
internally cinchona, mineral acids, iron, iodine and opium to 
keep patient comfortable. 

With all these complications the immature germ of a non- 
infecting chancre never affects the blood. 

Indurated Hunterian Infecting Chancre.— Suppose, for 
convenience of description, we take the pock on the organs of 
generation. As this is the ordinary visible means of ingress, 
we select it because it is more apparent ; there are a hundred 
other channels, by close contact, breath, kissing, clothes, milk, 
beef, and we might cite the cases of professional tattooers who 
have contaminated thousands of persons by their saliva. 

In the infecting chancre, a single living germ finds its way 
through a scratch or abrasion of the cuticle to the true skin, — 
a secreting membrane, — it breeds, forms a nidus or reservoir, 
and if it is not disturbed before the eighth day, it shall have 
multiplied a hundred fold, and so rapidly that even the dis- 
tended veins leading from the inoculation are incapable of 
carrying them fast enough into the blood, so colonies are left be- 
hind which form a ridge or eminence, which is termed an in- 
duration. It is simply a mass of germs, an aggregation which 
will by and by find its way into the circulation. Whenever 
those micro-organisms or carrion enter the blood they are safe ; 
their living particles find protection and nutrition there. If 
vital force is moderately good, the germ may lie dormant or 
be held in abeyance by a high standard of health ; nevertheless 
the individual can transmit it to others, especially to his off- 
spring. Let vitality be depressed by any cause, then growth 
and multiplication is active even in proportion to the deterio- 
ration from health; and if there is any localized weakness there 
the germ will more abundantly congregate and grow, giving 
us chronic ill health, obscure diseases of the vital organs, 
as the brain, heart, lungs, bones, mucous membrane, skin 

From the moment that the germ enters the body, till its 
death or destruction in the body, for it must die there, systemic 
syphilis is a contagious and infectious disease, whether it be 
latent or active. Suppose, then, that vital force is depreciated 
and the germ merges into activity and growth. Simultaneously 
with the entrance of the germ into the body, if vital force is 
feeble, or six months later if somewhat stronger or even years, 
subsequently, an indescribable train of symptoms make their 
appearance in no definite order. There may be languor, lassi- 



DISEASES OF THE BLOOD. 145 

tude, debility, even fever — if the skin is feeble the germ may 
appear there in some form or grade corresponding to the con- 
dition of vital force — if mucous membrane be feeble, colonies of 
germs will settle there, giving us various forms of ulceration, 
but it has now blended with it the oidium albicans of aphthae ; 
but on skin and mucous membrane it is easily recognizable 
in the Cucasian by its copper-colored appearance and lack of 
sensibility — if the bones are feeble the germs will lodge there 
giving us periostitis with nodes; ostitis with necrosis and 
caries — they often find their way into the most delicate parts — 
one even can estimate or approximate their growth and their 
destructive action on the blood by the degree of nocturnal pain 
in the bones, the tenderness of the sternum and enlargement 
of the post cervical glands of the neck; they are never failing 
criterions — the matrix of hair suffers an invasion and the hair 
drops out. Tuberculse are created, mucous tubercles or patches 
become common at points where skin and mucous membrane 
meet, lips, vulva-anus — often iritis of vital force is greatly 
shattered, with deafness and brain affections ; in some cases 
the onyx of nails are copper-colored and often rot or crumble 
— ulceration of tongue, hard and soft palate, perforating ulcers, 
larynx, trachea — elevations and gummy deposits — caries and 
necrosis of the cartilage and bones of the nose, and in a large 
per cent of cases the germ invades various vital organs as the 
brain, spinal cord, lungs, heart, liver, kidneys, never appearing 
on skin or mucous membrane at all. 

In hereditary syphilis cases in which the father transmits 
the disease to his offspring, the child may apparently be 
born healthy, and at some period, usually within six weeks 
after birth, the original disease makes its appearance on skin, 
or mucous membrane or elsewhere, besides it has indelible 
marks in the epiphysis of its long bones. In another class of 
cases, the skin at birth is sallow, withered and contracted ; 
most commonly we perceive excoriations around ears, arms, 
lips, mouth, joints, and throat, copper-colored in appearance. 
There is also in numerous instances amyloid or starchy disease 
of liver. 

If the Caucasian contracts the venereal disease, either in its 
high or low potency — or immature or perfect germ — infecting 
or non-infecting form from any other race, such as the Mongo- 
lian, Negro, Indo-American, it exhibits an intensity, virulence 
and malignancy greater than twenty per cent; besides it is in- 
tractable and difficult to eradicate. 

When it occurs among races with an active pigmentary 
gland in the skin, if the disease manifests itself there, it stains 
that gland deeper — the skin of the jettest black will be blacker 
in follicles or patches in which the germ locates. 

19 



146 DISEASES OF THE BLOOD. 

As a result of the fearful increase of syphilis, our washer- 
women suffer most, or those necessitated to do the washing of 
the afflicted. It is impossible for those in the private walks of 
life to realise the extent to which the disease has penetrated — 
its degrading or retrograding effect; its rapid increase and 
widespread dissemination, and its blasting action on our 
youth. No greater misfortune could befall a bright buoyant 
young man than to become the victim of this disease, with this 
germ lurking in his blood — to him the charms of youth are 
extinguished — he becomes preternaturally old and petulant 
— his existence is darkened, and he becomes, insensible to all 
the finer feelings of manhood, duty and affection. 

The social evil is the breeding pond whence emanate the 
germs, and this has become woven into the web of modern 
society — it has penetrated our homes, our workshops, our 
schools, even our churches and benevolent institutions, and 
the question suggests itself, What can be done? Its dissemin- 
ation cannot be prevented by license, or weekly inspection of 
the inmates. It is impossible, as there are seething brothels at 
every corner in our large cities, covered by any kind of trade, 
or occupation ; ostensibly a shop, cigar, liquor, millinery 
corset or some other depot, but in its varied apartments and 
blighted boarders a manufacturing brothel of disease and 
death. The whole basis of society in our larger cities is rotten 
— eighty per cent of their population is tainted. Something must 
be done to rid us of those modern hells, those nurseries of vice, 
those abodes of moral, mental and physical corruption, those 
agencies of human degradation — our very existence as a nation 
is threatened. 

As we are a Christian nation we naturally look to the church 
for an earnest, united, energetic effort. For this purpose we 
want more powerful preachers — men of riper knowledge and 
greater experience of the world — more keen and higher train- 
ing to grapple with this gigantic evil — men capable of min- 
istering to the bold, keen intelligences and arts and deceptions of 
vice. The earnest hope of every Christian is that the clergy 
would rouse to the task and enter this new field of moral and 
physical corruption. Or shall we, the great civilizing race of 
the world, acknowledge that we are unable to cope with this 
evil? 

Must we confess that this shocking and unparalleled condition 
is only an outcropping of a universal, underlying rottenness? 
Oh no, we must proceed against this social evil, not because it 
offends public morals ; — not because it is a great national 
enemy, nor an enemy of public virtue ; not because it de- 
moralizes and debauches our children and its lewdness is a 
shame and disgrace in the eyes of the world ; not because it is 



DISEASES OP THE BLOOD. 147 

sapping the vitals of our people and causing our very founda- 
tion to totter; not because it is unclean and spreads a loathsome 
disease, but because it is an enemy to God and man, mocks 
Christianity, retards progress, arrests human felicity, shortens 
longevity, and destroys the higher civilizing function of our 
race. There should be no listless apathy or toleration among 
this wilderness of vultures. By refusing to unite in an effort 
for its extinction, we become participaters in the degradation 
it engenders. 

We do not believe in the importation of syphilis — that it 
originally came to this country in that form. Oh no, we can 
prove it to be the degraded living matter of the prostitute's own 
body, brought about by promiscuous sexual intercourse. We 
cannot shut our eyes to the fact of a woman having sexual 
congress with eight or more men in twenty-four hours, day after 
day, week in and w T eek out, whose vaginal mucous covering has 
lost its rosy tint and become purple and cold as an icicle with- 
out disease being present. 

The disease is of our own production, and all lovers of their 
race and their country must look at it as our national ulcer ; 
an eating cancer, a gnawing worm in our nation's vitals, a 
poisonous mushroom tainting society to its centre. 

In the recognition of constitutional syphilis we need no 
history, as the disease may reach us in a great number of ways ; 
what we depend on is the copper-colored appearance of mucous 
membrane or skin, such as the roof of mouth, pains in bones 
at night, pain in the sternum, and enlargements of the post 
cervical glands of the neck; debility, loss of hair, copper-colored 
^appearance of root of nails, grave changes in periosteum and 
bones, nodes, thickening, dry husky condition of throat, perfor- 
ating ulcers, and other points as enumerated under symptoms. 

Inoculation of the syphilitic germ has been foolishly recom- 
mended as a protection, and members of the profession have 
been base enough to try it, contaminating those inoculated 
every time it has been performed, even repeated inoculations 
only aggravate its intensity. The insertion of the venereal 
virus under the skin ought to be regarded as a criminal act. 

Treatment. — There is no possible doubt as to the thorough 
destruction of the disease germ in the blood and a perfect cure 
being effected, and the affected individual capable of becoming 
the father of children, free from the disease. The length of 
time for destruction to come will depend greatly on the means 
employed. Where expense is no object, in a few months, where 
means are more limited longer, but a cure can only be effected 
by the escape of the living germ into other living or organic 
matter, or its total destruction in the blood, as no living poison 
can be eliminated. First of all, the diet should be light and 



148 DISEASES OF THE BLOOD. 

very nutritious ; meat, boiled fish, milk, cream, raw eggs ; warm 
clothing, flannel, and avoidance of cold or damp. Alcoholic 
vapor bath with iodine or sulphuric acid three times a week, 
keep liver active with chionanthus. Then place the patient 
upon alteratives and tonics, and in selecting those remedies, 
choose those capable of destroying germs. Keep that idea ever 
before the mind. Such tonics as glycerite, ozone, ozone water, 
compound tincture cinchona and nitric acid, chlorate potass, 
and muriatic acid, etc. 

Among alteratives the best germicides are compound ex- 
tract saxifragia ozonized, or compound phytolacca, iodide of 
potass, iodide of sodium. Chloride of gold and platinum are 
feeble remedies. Ozonized extract of saxifragia is the best 
remedy in the materia medica. Nitric acid one drachm to four 
ounces of tincture of cinchona compound. Dose. — One tea- 
spoonful thrice a day. Most efficacious. 

As to the skin affections we pay little attention to them, 
simply depending upon the constitutional remedies. 

Ulcers in mouth contain not only syphilitic germ but the 
oidium albicans, and require touching when within reach with 
nitric acid, and mouth washes of chlorate of potassa and 
glycerine or borax. 

If in the nose and pharynx, wash out the nose with the catarrh 
fluid ozone et chlorine. 

If the germs are lodged in some internal organ, as brain, 
lungs, liver kidney, adhere to the treatment, but in addition 
apply to different parts of the body, beginning between the 
shoulders of stibiate plasters (made with one part of powdered 
tartarized antimony and three of adhesive plaster, melted to- 
gether) the size of an ordinary card. As soon as good pustules 
are produced, poultice. This has the effect of attracting the 
germs to weakened parts, as the antimony is very depressing 
to the skin. Pursue this till the internal remedies kill the 
germs. In the arrangement of remedies tonics before meals, 
alteratives two hours after both well diluted with water ; yellow 
dock, sarsaparilla, iodine. 

ANJEMIA. 

Poverty of the Blood. — A condition in which the red cor- 
puscles are diminished or reduced to eighty, sixty or even 
lower than forty to the one thousand parts, instead of one 
hundred and thirty, which is the healthy standard. The liquor 
sanguinis is also poor in albumen, but may contain an excess 
of salts. 

The common causes are poor food, over- work, absence of 
sunlight, deleterious trades, as operations in lead, mercury, 
phosphorus, the fumes of which are powerful agents in im- 



DISEASES OF THE BLOOD. 149 

poverishing the blood ; disease, hemorrhages, drugs, atrophy 
of gastric glands, defective assimilation, lack of fresh air and 
muscular activity, malignant disease, imperfect nutrition and 
impaired sanguinification, excessive loss or drain of vital 
secretions, excesses, passions, mental shocks, and it may be due 
to parasites, as the trichinae, taenia, and other micro-organisms 
that find their way into the alimentary canal by food and 
water. 

The Ordinary Symptoms of anaemia are great debility, 
pallor, blanched appearance of skin and mucous membrane, 
loss of appetite, in some cases with an intolerance of food, often 
nausea and vomiting, constipation or diarrhoea. As a rule, in 
the earlier stages of the disease, the breathing is quiet only on 
exertion, which produces marked breathlessness ; but in the 
advanced stage we have great difficulty of breathing. Attacks 
of syncope or fainting fits are liable to occur, but not so fre- 
quent as one would expect ; the action of the heart is generally 
regular and quick, often very feeble ; the impulse is often 
widely visible, undulating and thrilling ; the area of cardiac 
dullness is increasing lateralty, due either to dilatation of the 
heart or retraction of the lung. Aortic and pulmonary systolic 
murmurs, with palpitation in the large arteries of the neck 
often visibly pulsate and are the seat of local murmurs. The 
jugular hum is seldom absent, and pulsation of the jugular 
vein is often observed. The pulse is soft and compressible, 
quick, jerking, empty. There may be enlargement of the 
thyroid, protuberance of eye-balls, with vertigo and nausea, 
volitantes or specks or spots before the eyes, albumen in urine, 
oedema and dropsical effusions into the chest, pericardium, 
peritoneum and cellular tissue, amenorrhoea, occasionally fatal 
syncope, coma. 

There is usually no enlargement of either liver, spleen or 
lymphatics, and albuminuria is slight and transient. 

As the disease is often due to hemorrhage, epistaxis, haemop- 
tysis, menorrhagia, haematuria, we are liable during an attack 
to have a recurrence which should be guarded against ; but 
in the sanguine or hemorrhagic diathesis, this is so persistent 
that it is liable to occur even in the retina of the eye, being 
most abundant around the optic nerve entrance. It is frequently 
associated with white spots and areas due in part to leucocyte- 
like cells, in part to degeneration of retinal tissue. Slight febrile 
symptoms are the rule. 

Anaemia is often divided into simple and pernicious, the 
latter term being applied to it when due to bad food, conjoined 
with pregnancy or lactation, or repeated pregnancies, or 
digestive or intestinal disorders. Malarial influences in the pro- 
duction of haematuria give us the best and most common illus- 

20 



150 DISEASES OF THE BLOOD. 

tration of pernicious anaemia. It is not well to call the pro- 
found blood change that is set up by direct nervous shock, 
fright, grief, very pernicious, as it is a factor of simple anaemia. 

The cause for anaemia should be sought for in two directions, 
diminished activity of blood formation, or excess of activity 
in blood destruction. 

The degree to which the haemoglobin may be diminished 
without being fatal, is about one-fifth of its normal quantity. 
After the blood is drawn we observe irregular massing of cor- 
puscles into pear-shaped, biscuit-shaped or globular forms, and 
the coloring matter accumulating in the corpuscle at one point, 
indicating a greater proneness to form changes in healthy 
blood. At the same time can be seen small fragments of cor- 
puscular matter, evidence of the disintegration of the corpuscles. 

In our diagnosis of anaemia neither the spleen, nor lym- 
phatic system is to show any evidence of change ; if they do, 
then it may come under another head. 

The theory of the blood formation of the bone marrow has 
not been sustained. The alterations in the blood and marrow 
in the form of altered corpuscles are met with in cancer, and 
they seem to be dependent on the cachectic state rather than 
the cause of it, and not in anaemia. 

There are three other blood diseases that bear a close resem- 
blance and analogy to anaemia, — a resemblance clue to the factor 
common to all of them : the diminution of the oxygen-carriers 
of the blood. In anaemia, a decrease of red corpuscles ; in 
chlorosis, an imperfect evolution of the blood ; in leucocythaemia, 
an increased production of white corpuscles and an incomplete 
conversion of them into red ; in pseudo-leucocythaemia there is 
deficient formation of red corpuscles ; in leucocythaemia, h}>per- 
trophy of spleen almost invariably present; in pseudo-leuco- 
cythaemia, the lymphatic system greatly infiltrated. 

Chlorosis is essentially a disease of nervous origin; centres 
of life are depressed, hence the process of cure is slow but pro- 
gressive. 

In the Treatment of anaemia general principles must be 
observed as to the removal of cause, enjoining quietness or 
rest in recumbent posture, attention to clothing and secretions, 
abundance of fresh air and sunlight. The true aim in treat- 
ment is to introduce as quickly as assimilation will take it up, 
the most nutritious food with mineral acids, iron, cinchona and 
other tonics. The nourishing diet embraces milk, raw eggs, 
restorative soup, raw beef, essence of beef, blood, fish, poultry, 
roast beef and mutton, at stated intervals with pepsin if 
digestion is feeble. 

Our best remedies are those that increase blood formation 
most rapidly. Aromatic sulphuric acid and sulphate of qui- 



DISEASES OF THE BLOOD. 151 

nine : one ounce of the former to thirty grains of the latter. 
Dose — fifteen to twenty drops thrice daily in water ; or com- 
pound tincture cinchona and simple syrup, of each two ounces; 
to which add two drachms of muriatic acid. — Mix. Dose — 
a teaspoonful thrice daily in water. 

Benefit will be derived from iron, provided it does not cause 
irritation or fever, or provoke constipation, the acetate or muri- 
ated tinctures or iron by hydrogen. 

To prepare the acetated tincture, take a pound of lath nails 
and cover with good strong, sharp cider vinegar, or dilute 
acetic acid, steep for ten days, then strain. Dose. — Half a tea- 
spoonful in a glass of water three times in twenty-four hours, 
or fifteen drops of the muriated tincture in the same quantity 
of water, and as frequent. Iron by hydrogen operates well in 
the following combination : 

Iron by hydrogen, thirty grains ; sulphate of hydrastin, 
thirty grains ; sulphate of quinine, twenty grains ; solid ex- 
tract nux vomica, eight grains. — Mix. Make thirty pills. One 
every four hours. 

In administering those remedies, select one preparation of iron 
to one of tonic ; give each every four hours, two hours apart. 
Open bowels with nutritive enemata or suppositories. 

As the patient progresses to recovery ozonized glycerine 
should be given, as it supplies deficiencies in the blood. It is 
an invaluable remedy in anaemia — aids powerfully in the 
restoration of the devitalized fluid to its normal constituency. 

When recovery takes place, a change of air to the sea shore, 
if good fresh food is available, is judicious. 

CHLOROSIS. 

A peculiar form of anaemia occurring in young persons of 
both sexes, but most common in the female about the age of 
puberty. There is a defect in the normal evolution of the red 
corpuscles — the development of the corpuscles up to a certain 
point, but no further. The red corpuscles are small, pale, and 
besides being dwarfed in size are diminished in number. 

The cause is some nervous defect, as some demand upon the 
nerve forces ; in males a common result of masturbation and 
deleterious trades ; in girls precocity due to modern education, 
and many of the causes that operate in the production of 
anaemia. 

Symptoms. — General symptoms of anaemia, with a wax- 
like hue of face, yellow pallor of skin, whence the name "green 
sickness." Deficient or depressed appetite, foetor of breath, 
heavy coat on tongue, skin dry, constipation, abundant limpid 
urine, weak quick pulse, hysteria. If a woman, pale, scanty 
menstrual discharge ; if a man, his semen entirely destitute of 



152 DISEASES OF THE BLOOD. 

spermatozoa. Leucorrhoea in women, often a thin gleety pros- 
tatic discharge in men. Languor, listlessness, head and back- 
ache, palpitations, cardiac and vascular murmurs. Occasion- 
ally enlargement of thyroid and protuberance of eye-balls. 

The Treatment is very similar to anaemia. Same diet and 
attention to the secretions ; bathing, followed by frictions, flan- 
nel clothing, and remedies to act more efficiently on the nerv- 
ous system. 

If that fail, put patient under the same treatment as for 
anaemia of the brain and spinal. 

LEUCOCYTHJEMIA. 

White cell blood, a morbid condition of the blood in which 
the white corpuscles are greatly increased in number while the 
red are much diminished, usually found connected with hyper- 
trophy of the spleen. 

As to the cause of this white cell disease of the blood, we 
can lay down nothing definite. It has been assigned as a 
sequelae of diseased or caked spleen in third stage of inter- 
mittent fever specially, and other malarial conditions. It is 
difficult to harmonize the alleged causes as attributable to that 
gland. We know that the spleen is a ductless gland, the great 
store-house of red blood, that in cases of long fasting it plays 
an important part in the nutrition of the body. It acts also as 
a sort of safety valve to the heart in cases of chill or rigor, 
when there is a determination of the blood from the surface, 
and in the cold stage of ague it is greatly engorged. Whether 
this repeated congestion impairs its function if it does elevate 
or raise the white corpuscles to red we cannot say, or whether 
it is not really the poisonous action of the malarial, paludal 
and kindred germs on the blood factors that are the real source 
of the trouble. 

Another idea has been broached, that the seat of the emotions, 
or moral nature of man, is chiefly located over the spleen and 
left kidne} r ; that the great sympathetic has some mysterious 
influence over the blood formation. 

Those that argue on this, cite the fact that women and other 
races in whom the development of the visceral brain is ar- 
rested or rudimentary, seldom, if ever, suffer from white cell 
disease, — a more plausible theory than localizing it in bone 
marrow. 

The spleen with the lymphatic system, in some mysterious 
way, acts an important part in the elaboration of that vital 
fluid, all presided over by the nervous system. There is a de- 
fect somewhere, and one of great importance. 

Symptoms. — Great weakness and debility, anaemic pallor, 
with all the other symptoms of anaemia; disordered respiration, 



DISEASES OF THE BLOOD. 153 

loss of appetite, mental depression, abdominal swelling, with 
enlargement and induration of the spleen; sometimes diar- 
rhoea, at others, constipation, nausea, jaundice ; often hemor- 
rhage from nose, lungs, stomach ; jaundice, anasarca, ascites, 
prostration, ending in death. Very chronic, lasting usually 
quite a number of years. 

The morbid condition is characterized by an excess of white 
corpuscles in the blood, with great enlargement, induration of 
the spleen, often as large as a child's head, its proper structure 
obliterated, filled with coagulated blood, soft and friable, and 
a mass of bacteria. Oftentimes we have a peculiar inflam- 
mation of the retina. 

In the Treatment of the white cell disease, our treatment 
consists of the best of diet, secretions well regulated, flannel 
clothing, rest and general alteratives and tonics, and the irri- 
tating plaster applied over spleen, and this continued for years. 
Among our best tonics are cinchona, Hydrastis, mineral acids 
and iron, and our best alteratives are ozonized glycerine, iodide 
of potass with carbonate of ammonia, chloride of potass, 
compound extract saxifraga. 

ADENOMA. 

Pseudo-leucocythsemia is a peculiar disease of the blood, like 
leucocythsemia dependent upon an enlargement or hyper- 
trophy of lymphatic glands ; glands of neck, axilla, groin sym- 
metrically enlarged, not inflamed or fused together; thoracic 
and abdominal glands also affected. Patient becomes weak, 
loses flesh, soon out of breath on exertion, symptoms of pres- 
sure at base of chest or abdomen, gradually increasing debility. 
It is also called Hodgkin's disease. 

It is well known that the lymphatics preside over or are 
carriers of nutrition or lymph, but how they influence the 
blood in the production of white cells is unknown. The spleen, 
lymphatics, mesentery, suprarenal capsules, and the pink 
marrow of the bones constitute the great lymph channels; in 
each or all of them when obstructed, damaged or diseased, 
there is the prevailing characteristic cropping out — excess of 
white corpuscles. 

Alteratives and tonics should be persevered with. 

GRAVES' DISEASE. 

This name has been applied to a complication of three symp- 
toms often predominating in anaemia, chlorosis, leucocythsemia, 
phthisis, viz.: palpitation of the heart, protuberance of eye- 
balls, aud enlargement of the thyroid gland. It is very com- 
mon among women, and men addicted to masturbation are its 
victims. There is connection between the three symptoms and 



154 DISEASES OF THE BLOOD. 

the generative organs. A neurosis of the cervical sympathetic 
nerve is the cause of the affection. Cases are stubborn and 
chronic, depending on the cause as to whether there be syphi- 
lis, tuberculae or other taint or germ, or simply a state of 
anaemia. 

The treatment will depend on cause, ozonized remedies sel- 
dom failing in effecting a cure. 

PURPURA. 

A disease of the blood, in which there is a degeneration or 
breaking down of the red corpuscles and capillaries, which 
predisposes them to rupture and leads to extravasation of blood 
into the skin and upon mucous membrane. 

The causes are generally a tubercular habit, or some influence 
calculated to depress the vital powers, as isolation, sameness of 
diet, monotony, absence of sunlight, sedentary occupations, 
over-crowding, deleterious trades, insufficient or bad food, glu- 
cose or sugar, over-work, privation, and indeed any cause that 
tends to impair the general health, and thereby the process of 
blood formation. 

Symptoms. — Usually preceded by lassitude, faintness, pains 
in limbs, accompanied with marked debility and depression of 
spirits; pulse feeble and often frequent; heats and coldness; 
sallow and dusky complexion; often bleeding from nose; pain 
about stomach and craving food, although tongue be coated 
and breath foetid ; palpitation, giddiness, constipation, swelling 
of the feet, albumen in urine. When acute, small haemorrhagic 
spots, petechia on the body, when chronic, large patches, vibices 
and ecchymosis, and in all states there is enlargement, and, to 
some extent, softening of spleen. 

Its duration is very indefinite, in some cases limited to a few 
days, in other cases months or years. It occurs at all ages, but 
especially from the age of puberty upwards. 

As to the loss of vital tonicity in the red discs, and a rup- 
turing of the walls of the capillaries permitting of the extra- 
vasation, there can be no doubt, but that the same exists in 
scurvy. Extravasation in both affections is liable to occur 
from the free surface of mucous membrane in the skin, in 
serous cavities and within the parenchyma of organs. In pur- 
pura there is an entire absence of the swollen, spongy, pallid, 
or livid gums, and peculiar fcetor that we have in scurvy. 
There is as a rule more depression of vital power in scurvy 
than in purpura; also swelling of the muscles and joints rarely 
takes place in purpura. 

Purpura when occurring alone is not a serious affection, but 
purpura haemorrhagic implies great danger from loss of blood 
and its extravasation into serous cavities of brain, lungs &c. 



DISEASES OF THE BLOOD. 155 

Treatment. — The management of a case is very simple — 
attend to skin, kidneys, bowels, flannel clothing, rest, abund- 
ance of fresh air, sunlight, plenty of good animal food, and 
fresh fruit and vegetables. 

Digitalis should be given to keep haemorrhage in abeyance, 
to diminish the area of the circulating fluids by its action on 
the arteries — an invaluable drug. Cinchona and mineral 
acids as follows : Compound tincture cinchona, four ounces ; 
aromatic sulphuric acid, one ounce. — Mix. One teaspoonful 
thrice daily in water. 

Another good method of treatment is fifteen drops of muriate 
tincture of iron in alternation with three-drop doses of muri- 
atic acid in water. Turpentine, phosphoric acid are often of 
utility. 

Black Leg. — This is simply an aggrevated form of purpura, 
in which one leg is usually affected, and that the left, often of 
a purple or livid color from the toe to the groin, and in bad 
cases perfectly black. It is very common among pork eaters, 
lovers of sour krout, and epicures who have potatoes boiled in 
vinegar, and also among those who are compelled to live on 
preserved animal food in which nitrate of potassa and pearl- 
ash has been used in curing. 

The lymph canals, spleen, suprarenal capsules, and pink 
marrow of the bones are seriously affected, hence recoveries are 
slow, often taking some months to get around. 

The same treatment as for purpura, but even a more gener- 
ous, variated diet is indicated, and an absolute avoidance of all 
canned, salted meats, and partially decomposed vegetables with 
vinegar. In no case should there be any deviation from any 
method to increase the perfect blood formation. 

SCURVY. 

A complex disease of the blood, combining the essential ele- 
ments of anaemia, purpura, and a deficiency of the alkaline 
constituents of that fluid. 

Its cause is supposed to depend on a smeness of diet, a 
want of variation, and to the absence of food deficient in the 
salts of potash, as fresh meat, fruit, vegetables, milk. 

Symptoms. — The earliest and best marked symptoms are 
observed in the countenance ; the face is pale, and may be 
bloated; the eyes and lips have a dirty hue; the features are 
somewhat depressed; the gums are spongy, livid, and bleed 
when slightly irritated; teeth loose, breath very offensive. 
There is great lassitude and debility, pains in the legs, limbs 
very feeble, joints stiff, unable for any exertion. There is great 
difficulty of breathing, skin dry and harsh, sometimes rough 
and scaly, especially around joints, oftentimes puckered ; al- 



156 DISEASES OF THE BLOOD. 

though more generally it is shining, with patches or spots of 
brown, blue, black or livid hue. These patches are first seen 
on the legs or thighs, but generally extend over the entire 
body, except the face, and the disease continuing, the feet and 
legs become (Edematous. 

If not arrested at this point, the symptoms increase in 
severity, the gums become more livid and swollen, the breath 
more offensive, the pains more severe, and so with the other 
symptoms. In the later stages there is often haemorrhage from 
the mucous canals, and the loss of blood is often so great as to 
prostrate the vital power of the patient. 

In these stages, the evacuations from the bowels are often 
frequent and offensive, and we often have scarbutic dysentery, 
albumen in urine. The pulse is jerking, appetite impaired, 
intellectual faculties slightly affected. 

In nearly all cases there is a tendency to faint on the slightest 
motion or exercise, which is often fatal. 

Healthy Blood. — Water, 788.8; solid constituents, 211.2; 
fibim, 3.3; albumen, 67.2; blood corpuscles, 133.7; salts, 6.8. 

Blood in Scurvy. — Water, 847.9; solid constituents, 150.1; 
fibim, 6.5; albumen, 84.0; blood corpuscles, 47.8; salts, 9.7. 

Treatment. — Rest in the recumbent posture; attention to 
liver, skin, kidneys; fresh air, generous diet, wholesome animal 
and vegetable food — fresh meat and boiled fish — juicy, rare 
meat; all kinds of vegetables, with fresh fruit in abundance. 
Precisely the same treatment as for purpura, with the excep- 
tion that five grains of chlorate of potassa in water should be 
given three times a day, in order to supply the deficiency of 
alkalies in the blood. Cinchona and mineral acids are of great 
efficacy. 

In land-scurvy, change of diet is of the greatest importance, 
and an avoidance of salted meats and fish. 

Pellagra, or Scurvy of the Hills, used to be confined exclu- 
sively to the Alps, but several well-marked cases have taken 
place in Montana and Arizona. It is a species of scurvy — a 
blood disease, with an altered state of skin, the eruption being 
symptomatic of the blood disease. The cause is a want of va- 
riated food, or insufficient nourishment. 

It ends in mania, imbecility and slow death with softening 
of brain and spinal cord. 

When first seen patient should be removed to better quarters 
and have a variated diet, because when once established all 
remedies fail. 

The best success has attended the use of a highly annualized 
diet, with vegetables. The glycerite of ozone and kephaline 
operate most favorably in aiding blood formation, their use 
being pre-eminently constructional to brain and blood. 



DISEASES OF THE BLOOD. 157 

BRONCHOCELE. 

This is characterized by an enlargement of the thyroid gland. 
The entire gland may be affected, or its centre, or either lobe. 
The swelling is usually unassociated with pain, and causes little 
inconvenience, beyond the deformity it produces, unless it 
presses upon the adjacent parts. 

Causes are very varied. It may be due to water impreg- 
nated with lime or magnesia; to tuberculae; to irritation, re- 
flected from the organs of generation to the nerves that supply 
the thyroid, causing enlargement and congestion; to uterine 
disease, or an anaemic condition of blood. 

It is a true hypertrophy and is divided into three forms, accord- 
ing as the vascular, glandular or connective tissues are involved. 

(1.) Vascular Goitre is most common in this country, and 
consists merely of engorgement, congestion from suppressed 
menstruation, masturbation, gonorrhoea, amenorrhcea. 

Branches of the sympathetic nerve covering the anterior 
portion of the uterus, clitoris, penis, are reflected over the 
mamma and thyroid, hence the connection. Besides, the gland, 
from its peculiar function of aiding in controlling the circu- 
lation in the brain, is very profusely supplied with blood-vessels 
and is lianle to take on congestion from very slight causes. 
Vascular goitre often terminates in rupture of vessels, blood 
absorbed and recovery. In other cases calcareous degeneration 
may take place. 

(2.) Glandular or Cystic Goitre consists in a development 
of the glandular capsules and their distension, and is filled 
with a gelatinous fluid. 

(3.) The entire transformation of the structure of the thyroid 
into a calcareous or chalky mass. 

Symptoms. — The whole gland may be swollen or only the 
centre or side of it. Frequently no inconvenience but the 
deformity. In other cases distressing symptoms are produced 
by the pressure upon surrounding parts, and respiration and 
deglutition may be rendered painful and difficult by the com- 
pression of the trachea or oesophagus. In other cases severe 
constitutional symptoms, as anaemia, palpitation, mental depres- 
sion, dyspepsia; irregularity of uterine function, as scanty men- 
struation, profuse leucorrhoea. 

Its duration is somewhat tedious; much more common among 
women than men. 

Treatment. — The cause must, if possible, be ascertained and 
removed ; such as water, or irritation, or disease. Then a gen- 
eral alterative and tonic treatment inculcated, with the very best 
of food. Whether caused directly by tubercula or not, that 
condition is inseparable from it; hence special drugs for the 



158 DISEASES OF THE BLOOD. 

destruction of that germ, such as iodine and bromine in their 
various forms, tincture of iodine, iodine and glycerine, iodide 
of starch, iodoform. Bromine is not so active. Fluoric acid 
in an alternated solution is acquiring great repute in the cure 
of a great number of cases. Locally, organized clay is extremely 
efficacious, taking care to cause no redness of the skin. 

CRETINISM. 

This may be regarded as the utmost extent of deterioration 
that can be brought about in a human being by tuber culse 
without death. It may be regarded as an imperfect formation 
or development of the body, accompanied by a dwarfish stature, 
malformation of the head, which is flat on top and spread out 
laterally; mental imbecility, countenance vacant, devoid of 
intelligence, physical deformity in various degrees, mouth 
gaping, tongue protruding, saliva flowing, bronchocele, bru- 
talized habits, squinting, deaf muteism, blindness. 

This disease is common in valleys or gorges in which there 
is an absence of sunlight, and the inhabitants are necessitated 
to drink ice and snow water. In addition to those, stagnant 
air, filthy abodes, the ice or snow water loaded with calcareous 
matter, with extreme poverty, bad food, sensuality and other 
forms of mental and physical degradation. Consanguinity and 
incompatibility of temperament may also be a cause. 

When cretinism is developed it never can be transmitted,; 
an impure sustained breed cannot be produced. Procreation 
ceases ; a cretin never produced a cretin, nor an albino an albino. 
There is no establishment of a morbid race. 

Probably when our population reaches two hundred thousand 
millions, our inhabitants will be restricted to given areas, that 
the disease may be seen in our mountain gorges. 

The only treatment is the removal from the predisposing or 
exciting causes ; judicious moral control, careful mental training, 
pure mountain air, nourishing and variated diet, with the 
general treatment for tuberculaa. 

EMBOLISM. 

A morbid state of the blood, in which it has a tendency to 
clot or form fibrinous concretions, which either adhere to the 
walls of vessels or are carried onward by the current of the 
circulation, and plug up or impede its normal course. 

The causes are varied : in-door life, insufficient oration of 
blood by skin or lungs ; its imperfect decarbonism by the liver 
in drunkards ; the pressure of the gravid uterus on the liver, 
and non-ogygenisation by pressure on the diaphragm. It is 
present in ague, typhus and other fevers ; also in croup, diph- 
theria, pneumonia, scarlatina, erysipelas. It is also caused bj T 



DISEASES OF THE BLOOD. 159 

diseased vegetables, fruit, meat and cereals, such as ergot of rye, 
ustilago maidis, so that ergot during parturition produces it in 
mother and child, and is one of the most common causes of 
death to both. 

In an examination of the blood after death there is usually 
a large coagulum found in the heart ; fibrinous specks, patches, 
plugs can be seen in brain, lungs, heart, liver and arteries. 
On an examination of these clots or plugs by the microscope, 
they seem, in nearly all cases, to be a mass of bacteria. 

It is often difficult to recognize the disease during life as the 
symptoms are quite variable, but if any of the above causes 
exist, it it positively present to a greater or less degree, and 
particularly so if the patient complains of strange sensations 
about the heart, and has a tendency to fainting. 

In all diseases in which this \s present, or where it is suspected, 
the patient should be kept as quiet as possible in the recumbent 
posture, never being permitted to sit up, and nothing allowed 
to disturb him in any way, and have an abundance of fresh 
air. The diet should consist of milk, eggs, soups — the secretions 
attended to. 

In order to meet the pathological condition of blood, tincture 
of belladonna and alkalies should be administered. 

All acro-narcotic remedies have a wonderful effect in causing 
and maintaining a fluid state of the blood. Belladonna has this 
property in a high degree. A teaspoonful of the tincture in 
half a tumbler of water, of which a teaspoonful should be 
given every one or two hours, never administering it so fre- 
quently as to cause dryness of throat. 

In the sesqui-carbonate of ammonia we have an excellent 
alkali. This either alone or combined with a few grains of 
bicarbonate potassa soon relieves the condition ; besides, the 
ammonia is destructive to living germs in the blood. Bromide 
of ammonia answers well if a deposit of fibrin has taken place. 
Sulphate of soda is also valuable, so is the permanganate or 
chlorate of potassa. In diseases associated with embolism, iron 
and mineral acids should be avoided in treatment. 

The term thrombosis is applied to a clot of fibrinous blood, 
causing a partial or complete closure of a vessel. 

PIARRHJEMIA. 

Milkiness of the serum of the blood, or fatty blood, is met 
with in diabetes, chronic alcoholism, disease of the liver and 
kidneys, especially in Bright's and Addison's disease, in dropsy, 
nephritis and pneumonia. 

The presence of free fat and molecular albumen in the blood 
may be the result of indigestion, pregnancy and lactation. 
In the process of digestion the lactescence of the serum begins 



160 DISEASES OF THE BLOOD. 

about two hours after the ingestion of food, and continues for a 
few hours. 

The serum is found turbid, opulescent and semi-opaque, a 
condition, however, which is only transitory, and due to the 
absorption of fatty matter, formed into an emulsion by the 
pancreatic juice and absorbed as such in the duodenum. It 
is entirely due to the presence of fat granules, and molecular 
granules of albumen. The passage of chyle into the blood 
renders the serum turbid, the turbidity lasting until fatty 
matters' enter in combination with the free soda of the blood. 
This condition is the result of disease. 

Various explantions have been offered as to the occurrence of 
fatty blood in disease. Some attribute it to the passage of 
unaltered chyle into the circulation; others declare that the 
fat is set free in the blood for the want of a free alkali ; while 
another class maintain that it is fatty degeneration of the albu- 
men of the blood ; and others insist that it is dependent upon 
a new combination of fat. It is never found existing as an 
independent affection, being invariably associated with some 
other disease, usually of the liver or kidneys. 

GLUCOHJEMIA OR MELLITURIA. 

A saccharine condition of the blood. This may be due to 
various causes, as in certain depressed states of the stomach 
we have the starchy elements of the food converted into other 
compounds and absorbed into the blood. Sugar is a normal 
secretion from the liver in health, in disease it may be excessive. 
The use of alcohol so irritates that gland that there is an 
excessive secretion ; so with other liver irritants. If there is an 
irritation of the eight pair of nerves at their origin in the fourth 
ventricle, sugar is generated by the liver in such abundance 
that the oxygen inhaled by the lungs is incapable of burning 
it up, hence it is thrown back into the blood and thrown off 
by breath, sweat, tears, saliva, urine, fseces. 

In health, the sugar formed by the liver passes into the 
hepatic veins, the inferior vena cava, the right cavities of the 
heart, and thence by the pulmonary artery to the lungs, when 
it is consumed ; but when irritation exists, the sugar is in excess, 
and there is not sufficient oxygen inhaled to burn it up. 

The irritation may be in the liver or brain, sometimes in the 
stomach, the irritation being transmitted by the pneumogastric 
to the brain, from thence transmitted to the liver, causing it 
to secrete sugar ox a glucogenic substance. The treatment is 
exactly the same as that laid down under Diabetes, bearing in 
mind the essential utility of remedies to reconstruct the 
shattered nervous system, as the glycerite of kephaline, general 
tonics, and alteratives. 



DISEASES OF THE BLOOD. 161 



UKJEMIA. 

When from any cause the functions of the kidneys become 
impaired or suppressed, urea is no longer eliminated by those 
organs. It accumulates in the blood, producing what is termed 
ursemia. 

Probably several forms of poisoning are present, such as where 
the urea is decomposed into carbonate of ammonia; and when 
such a decomposition does not occur, probably there are also 
other poisons due to incomplete metamorphosis of nitrogenized 
waste into urea. 

This theory explains the variety of symptoms present, such 
as stupor, coma, stertorous breathing, epileptic convulsions, 
intoxication, twitching. 

It may come on abruptly with little warning, or may be pre- 
ceded by debility, impaired vision, obstinate vomiting or diar- 
rhoea; the breath has an uriniferous or ammoniacal odor. It 
is invariably present in three stages of Bright's disease. 

Besides being due to structural disease of the kidneys, it may 
be present in pregnancy and parturition, due to pressure of the 
uterus, producing renal congestion. Beer drinking is a common 
cause. 

Uryemic poisoning or intoxication is easily distinguished by 
attention to the following points : the urine is albuminous, scanty, 
or of a low specific gravity; oedema of the cellular tissue; fits 
are preceded by delirium, headache or giddiness, pupils dilated 
and fixed, breath ammoniacal, skin emits an uriniferous odor, 
disease of kidneys. And if these are not sufficient, paint a portion 
of the skin with cantharidal collodion; from the blister so pro- 
duced take the serum and place it under a microscope, and the 
crystals of urea are easily recognized. 

The treatment of cases of ursemic poisoning must be upon 
general principles. An attempt should be made by warm bath 
and jaborandi to get up a powerful action on the skin. The 
use of the jaborandi or its active principle does not require the 
use of diaphoretic teas, hence it is our most valuable diaphoretic. 

One-twelfth of a grain dose of elaterin should be given every 
three hours, so as to get a free serous action of the bowels. If 
successful, benzoate of soda or benzoic acid has a wonderful 
effect in neutralizing this blood poison. 

ACHOLIA. 

An arrest of the function of the liver, so that matters from 
which the bile is formed accumulate in the blood, producing 
toxaemia. It is a condition liable to occur in all diseases of the 
liver, as inflammation, acute atrophy, cystic, starchy and fatty 
degeneration, cancer, impermeability of the gall duct, gall stones. 

21 



162 diseasp:s of the blood. 

Symptoms will vary as to cause. There is apt to be peculiar 
nervous excitement, jaundice, delirium, convulsions, prostration, 
coin a, haemorrhage from nose, stomach, bowels, ecchymosis, etc. 

Treatment. — Active purgation with compound powder of 
mandrake, and a drop of croton oil. Nitro-muriatic acid in 
alternation with phosphate of soda. Benzoate of soda and 
other remedies used in chronic inflammation of liver should 
be tried. Stimulation over liver with nitro-muriatic acid, 
followed with hot packs of warm water acidulated with the 
same acid, and also to the entire body. 

ICHORRHJEMIA. 

A morbid state of the blood caused by the introduction of 
ichorous or putrid matters. Sometimes called septicaemia, when 
fatal without any local formation of pus, and pyaemia, when 
secondary abscess follows. 

Among puerpural women and surgical cases, very liable to 
appear if proper treatment or precautions are not carried 
out rigidly. 

Ichorrhaemia may manifest itself in a variety of ways. In 
some cases the patient seems to be so immediately and deeply 
affected by the morbid poison, that she or he dies before any 
local phenomena are exhibited. In another class of cases the 
intensity of the poison seems spent upon the liver or mucous 
membrane of intestinal tract; in the one case, nature appears 
to make an effort at elimination by the discharge of a copious 
quantity of black bile; in the other, by a severe attack of diar- 
rhoea or dysentery. In another class of cases, the serous mem- 
brane of the pleura, heart, peritoneal coat, or even the cellular 
tissue bear the brunt of the poison, so that pleurisy, pericar- 
ditis, peritonitis, erysipelas and boils may be present. Another 
class of cases exhibit themselves in profuse suppuration of liver, 
lungs, joints, glands, eyes and ears. 

General s}anptoms are, rigors, sweating, rapid pulse, sallow 
look, sweet hay-like odor of breath, diarrhoea, dysentery, with 
inflammation of serous membranes, rapid wasting, feebleness, 
prostration. 

The absorption of poisons containing the living germs of 
disease are the most productive of septicaemia, as the lochial 
products, the punctured wounds in dissection, the bacteria of 
erysipelas, bites of enraged men, rabid animals, venomous 
reptiles and insects, inoculations from scratches or abrasions 
from the secretions of those affected with contagious diseases. 
These living poisons multiply rapidly. They are taken by the 
veins, the lymphatic system becomes involved, and the entire 
blood the field of a living deadly poison. 

In the treatment the powers of life should be well sustained, 



DISEASES OF THE BLOOD. 163 

free full incisions made into suspected parts, and antiseptic 
poultices of yeast, charcoal, wild indigo applied; strong beef 
tea; pain subdued by anodynes. There is no elimination of 
living poisons, — they must be discharged in the blood ; hence 
our best and most powerful antiseptics should be used. Remedies 
like the salicylate of soda, that is capable of destroying the 
most virulent of living poisons, rabies and small-pox: one part 
in twenty thousand will prevent saccharine fermentation under 
the most favorable circumstances, and destroy disease germs. 
Carbolic acid and tincture of iodine, chlorate and permanganate 
of potassa, etc. 

RHEUMATISM. 

A morbid condition of the blood, in which there is a superabun- 
dance of lactic and butyric acid in the blood, which has a special 
affinity to irritate, if weak, the white, fibrous tissues of the 
body, as well as to irritate the fibrin of blood and muscle, a 
formidable disease, owing to the suffering it engenders, the 
intensity of fever, and the damage that it is likely to inflict 
upon the heart and blood. 

The predisposing cause is an impairment of the nerve centres, 
the co-ordinating chemical centre. The exciting cause, the 
generation of acid in the stomach, in the muscles and elsewhere. 
The nerve force which regulates the digestive secretion being 
impaired, the process of digestion becomes sluggish and retarded; 
food ferments, acids are evolved, the principal of which is lactic 
acid, which may be retained in the blood or eliminated. In 
healthy digestion the starch of the food is converted into 
lactic acid, which combines with the oxygen to form carbonic 
acid gas, in which state it is excreted by the lungs ; but owing 
to some unknown nervous defect, the lactic acid, instead of 
being so changed and thrown off, accumulates in the blood. 
But this cannot, in all cases, account for the great superabun- 
dance of acids. Whence, then, comes the lactic and butyric 
acids of rheumatism, if not from digestion ? Whence, then ? 
The haemoglobin of the venous blood, through the lungs 
becomes oxyhemoglobin. Hurried to the tissues, the oxygen 
of the arterial blood passes from the blood into the muscular 
tissue, where it is packed away. The oxidation takes place in 
the muscle itself. The muscle is always producing and dis- 
charging carbonic acid gas, and where it contracts frequently 
there is an increase in that gas. With much of its oxyhemo- 
globin reduced, the blood passes on as venous blood with its 
carbonic acid gas. When it arrives at the lungs the gas is 
discharged. The change in the muscular structure, the fixing 
of oxygen and exhalation of carbonic acid gas is regulated by 
the nervous mechanism, the co-ordinating chemical centre, 



164 DISEASES OP THE BLOOD. 

which restrains chemical action. Instead of the muscle fixing 
oxygen and throwing off carbonic acid gas, suppose some inter- 
vening change takes place in some degree, and what are those 
changes ? One of the first, the reaction of the tissue becomes 
acid ; the acid produced is lactic acid. In this way causes can 
be enumerated, all traced back to the original nervous defect. 
Whether that defect be a condition analogous to tuberculse, we 
cannot say. Isolation, sameness, monotony, deleterious trades, 
insanitary abodes, tobacco, whisky, excess of starchy or saccha- 
rine food, are prolific causes. Gastric catarrh is a direct cause. 

Cold, damp, exposure, injuries, mechanical violence operate 
in depressing white fibrous tissue, cartilage, bone, weakening 
tissue rendering them obnoxious to the irritating effects of the 
acids circulating through them in the blood. 

There are several forms: acute, when of short duration, and 
accompanied with fever ; sub-acute, same as acute but no fever ; 
chronic, when long continued and not accompanied with much, 
if any, fever, nor much pain; and rheumatoid arthritis when 
joints suffer inflammation, with evidences of both gout and 
rheumatism. 

The essential symptoms of rheumatism are an intense acid 
diathesis, breath, saliva, sweat, urine, and, if the bowels are 
loose, acid stools; almost all that is taken as food or drink is 
converted into acid. There is a perfect perversion of nutrition. 

In the acute form, these symptoms are followed by languor, 
restlessness, rigors and a fever, with stiffness and itching on the 
the body, as if following exposure to cold or damp. Painful 
condition increases pain or tenderness in one or more large 
joints ; very high fever, great constitutional disturbance, tem- 
perature, 102° to 103°, fatal cases, 105° to 110°. Pulse full 
and quick, bounding 140 to 160. Patient very helpless, unable 
to move or sleep, pain in joints agonizing ; skin bathed in sweat 
of a disagreeable acid or sour odor. Usually constipation, 
sometimes diarrhoea ; tongue moist but thickly furred. Urine 
loaded with uric acid, copious brick dust sedimen, or more 
frequently with urates, very acid. If the pleura, pericardium 
and endocardium, periosteum, synovial membrane, cartilage, 
bone are enfeebled by any depressing influence, the acid, in its 
passage into the blood through the weakened structures, gives 
rise to great inflammation and a tendency to metastasis; for if 
the standard of vitality is raised by local stimulants, the inflam- 
mation at once subsides, and may manifest itself in another most 
serious change ; the pericardium and endocardium of the heart 
becoming affected. Often complications with heart, pleurisy, 
pneumonia, inflammation of brain and its membranes. 

It is easily diagnosed by the extreme acid condition of the 
body and its secretions, and a deficiency of alkalies. The irri- 



DISEASES OF THE BLOOD. 165 

tating action of the lactic acid on depressed white fibrous tissue, 
or fib ro -serous membranes, which enter into the formation of 
joints, sheaths of muscles, tendons, pericardium, membranes' of 
brain and bone may be of a serious nature. The erratic form 
of the pain is due to the continuity of structure involved. The 
heart, of all organs, is the most likely to suffer, as it is so abun- 
dantly supplied with a large ramification of the great sym- 
pathetic, and there is probably no organ in the body that surfers 
so badly from the use of tobacco as it. 

Rheumatism mostly pursues a very definite course or form of 
its own, and deviations from that bodes no good. So long as the 
symptoms follow the usual and orderly evolution, though that 
may be severe, there is not much danger; but when unusual or 
strange symptoms arise, when danger threatens from unknown 
quarters, we do not like it. Articular rheumatism, though 
severe, when confined to joints or with but moderate cardiac 
complication, is a tolerably straightforward matter; but rheu- 
matic fever, with little joint affection and much delirium, or 
lung oedema, is quite a different thing. 

Treatment. — This is somewhat varied ; still, there are certain 
indications to carry out in all cases. We begin with an emetic, 
follow with a saline cathartic and a vapor bath, the patient 
put to bed between blankets, and have a flannel shirt, no cotton 
or linen being permitted near the skin; all painful parts wrapped 
carefully in woolen cloth, and the most perfect quietness and 
rest observed. If the heart suffers, apply mustard plasters at 
once over it. 

The fever should be controlled with suitable doses of tinctures 
of aconite and veratrum, and pain allayed with small doses of 
pulverized opium and diaphoretic powder. No rheumatic patient 
should experience pain — it is an injury to nutrition. Sponging 
the body with strong alkaline wash three times a day, heat to 
feet, the same as other fevers, must not be omitted. The diet, 
milk and lime water. For two or three days, and no longer, 
there should be made an effort to neutralize the acid of the 
body, and supply alkalies to the blood by the administration 
of twenty or thirty grains of bicarbonate of potash every three 
hours, and if there is much bony pain, five grains of iodide 
should be added. There can be little doubt but that potash 
shortens and alleviates the condition, but its continuance be- 
comes injurious to the stomach, an organ that we must take 
care of, make much of, and sedulously avoid giving it offence; 
but the iodide must be pursued with if in the bones. Besides 
controlling the fever with aconite and veratrum, relieving pain 
with persistent doses of opium, we must maintain the force of the 
heart, support the general strength and prevent the formation of 
lactic acid in such abundance. There are two remedies of great 

22 



166 DISEASES OF THE BLOOD. 

value, sulphate of quinine and salicylate of soda. The quinine 
is best given with aromatic sulphuric acid ; it stimulates the 
brain and cardiac plexus of nerves, lowers the temperature and 
pulse; it prevents the transference of oxygen to the red cor- 
puscles, and produces a decrease in the acids. The salicylate 
of soda enters into chemical combination with some of the 
constituents of the tissues and prevents their change. Wine 
of the root of colchicum is a very important remedy ; it should 
be given in fifteen-drop doses, at proper intervals, to act slightly 
on the bowels. If the skin keeps dry, keep up perspiration with 
compound tincture of serpentaria. There is no drug that acts 
so favorably in improving the co-ordinating chemical nerve 
centre as tincture of cimicifuga race., and no case of rheuma- 
tism should be treated without its use. It is an invaluable 
drug. The dose will range from ten to thirty drops, never 
administering it to produce headache or ringing in the ears. It 
also acts as a stimulant on the class of tissues implicated in 
the white fibrous, but not so active in that particular as tincture 
of white bryonia. To raise the standard of vitality of that class 
of tissue with bryonia, use asclepias. Iodide of potass has little 
effect either in the formation or elimination of uric acid. 

Another good method of breaking a case up in a few hours 
is, after attending to the preliminaries of rest, veratrum, opium, 
bathing, and a milk and beef-tea diet, to administer three times 
a day the following compound : five grains of iodide of potassa, 
five of carbonate of ammonia, five drops of fluid extract of 
cimicifuga race. Dissolve and mix in a glass of water. Between 
each dose give two grains of quinine and three grains of the 
solid extract of hyosciamus. Mix and make into two pills. 
This has a most salutary action in causing a complete arrest of 
the disease. 

When uncomplicated, the duration of rheumatism is short 
with a judicious use of the above remedies. If fatal, mostly 
due to some cardiac affection, and that organ, above all others, 
must be looked after, and if the mustard or dry heat is not 
sufficient to establish a renewal of life, then the pulverized 
opium and quinine must be given, and the heart's action stiffened 
by small doses of digitalis. 

Tonics, in the stage of convalescence, diet guarded ; mutton, 
poultry and beef must not be given too soon. 

CHRONIC RHEUMATISM. 

Sometimes a sequel to an acute attack, or it may come on 
independently, of itself. The fibrous textures around the joints, 
or the fibrous envelopes of the nerves, or the aponeurotic sheaths 
of the muscles, coverings of tendons, periosteum, etc., are those 
that suffer most. It receives different names from the locality 



DISEASES OF THE BLOOD. 167 

of the irritation; as neuralgia, when it attacks the nerves; lum- 
bago, when the muscles of the loins are affected ; sciatica, when 
the sheath of the great sciatic is involved; pleuradynia, when 
the pleura and intercostal spaces are implicated. In any case 
there is usually little constitutional disturbance ; but the sufferer 
is constantly annoyed and his existence made very miserable 
from chronic pains, causing him to be restless at night and 
destroying his comfort in the day time In some instances the 
pains are worse at night, being aggravated by the warmth of 
the bed; in others, warmth affords the greatest relief. The 
former is generally the case when the blood is circulating a 
poisonous material through the system, as in venereal rheu- 
matism, or in that due to derangement of the digestive organs 
with alcohol; the latter in rheumatism of an erratic kind, 
dependent on simple mal-nutrition, and brought into activity 
by cold. 

There is little difficulty in recognizing chronic rheumatism ; 
the mal-nutrition, the acid diathesis, the wandering pains 
attacking the white fibrous structures; the metastasis when 
the standard of vitality is raised, the condition of the urine 
loaded with uric acid. 

The management of chronic rheumatism requires great tact 
and good judgment. The general health should be improved, 
flannel clothing, avoiding exposure to cold or damp or injuries ; 
comfortable surroundings, cold douche and shower baths, watch 
the diet, forbid saccharine agents and animal food; neutralize 
acids, enjoin rest, administer tincture cimicifuga and aromatic 
sulphuric acid, and quinine. Then alleviation of pain, and 
special remedies, such as: — 

Compound syrup stillingia, four ounces; iodide of potash, 
three drachms; bicarbonate potash, two drachms; tincture of 
bryonia, one drachm; wine of colchicum, half an ounce. — Mix. 
A teaspoonful thrice daily. 

Other excellent combinations can be made, as dulcamara and 
iodide of potass, sassafras and iodide of sodium ; sulphur, nitrate 
of potassa, phytolacca, and iris versicolor, or saccharated sulphur. 

Local applications, either stimulants or anaesthetics, are not 
to be overlooked, as the irritating plaster or belladonna plaster 
in chronic rheumatic pericarditis; menthol dissolved in olive 
oil, with the addition of a little chloroform, is excellent in 
sciatica, rubbed in along the course of that nerve ; dry cupping, 
iodide of sulphur ointment, iodoform, tinctures aconite, bella- 
donna and chloroform, or oils of stillingia, solidago; or oils of 
turpentine, hemlock, sassafras, origanum; either one make a 
splendid liniment. The alkaline waters of some natural springs 
as those of Saratoga, Virginia, and others, act well on the sys- 
tem. 



168 DISEASES OP THE BLOOD, 

GOUT. 

So called because it is supposed to be produced by a humor 
dropping into the joints. It is a constitutional disease, giving 
rise to an inflammation of a specific character, usually affecting 
the smaller joints. There is a great tendency to hereditary 
transmission in the disease. It is usually accompanied by great 
pain in the affected joints, fever, with general disturbance, and 
especially by disorder of the digestive organs. The disease has a 
tendency to recur again and again with every nervous shock. 

Causes. — An excess of food by supplying an overabundance 
of nitrogenized material, for the blood creates an excess of 
urea and uric acid . Malt liquors, wines, sedentary habits, want 
of exercise, irregularity, lead poisoning, excessive mental strain, 
worry. 

It gives us urate of soda or uric acid and soda, which exist 
in the blood in a separate state, but a depression of the nervous 
system causes their union. The morbid state is aggravated by 
gastric and intestinal disorder, impaired appetite, furred tongue, 
acid or bitter eructations. 

The disease cannot be developed unless the blood contains a 
considerable quantity of uric acid and soda in some form. 
They never exist in the blood in combination before an attack 
of gout, but the moment they combine the disease is produced. 
Nerve force in health keeps them separate, so that they can be 
eliminated by the skin, kidneys and bowels, but as soon as nerve 
force is lessened or impaired these two unite. Good nerve force 
keeps them apart, but in shocks or debility the} 7 unite and crys- 
tallize as urate of soda. In lessened nerve force the uric acid seizes 
the urate of soda, and this is deposited in the tissues generally 
most remote from the heart and brain. This union generally 
arouses the nervous system, and a febrile effort takes place and 
it is warded off, but in subsequent attacks the febrile effort fails. 
In youth, before care, anxiety and disappointment have well- 
nigh worn out the brain, the nervous system is active, and in 
spite of dissipation and indulgence gout is rare, but as soon as 
age and care stamp their mark upon the great nerve centres, 
gout too often appears. 

Symptoms. — The attack may be preceded by debilhy, heart- 
burn, flatulence, dull pain in left side of chest, irregularity in 
heart's action, dry skin, urticaria, urine loaded with phosphates 
and urates containing albumen. It may come on suddenly 
in the night with acute pain in the great toe, heel, instep or 
wrist; rigors, followed by fever with great irritability and rest- 
lessness, tenderness and swelling of the affected part. The 
attack passes off, an interval elapses of length proportionate to 
the care taken, and then another attack follows. 



DISEASES OF THE BLOOD. 169 

The local affection takes place in weakened parts, then the 
inflammation and exudation takes place, so there is liable 
to be a change of location according as the vital forces of a 
part are strong or feeble. In this manner a metastasis occurs 
from the joint to some internal part, as the heart, stomach, lungs, 
brain, etc. When the kidneys act imperfectly, and there is a 
retention of the urate of soda in the blood, it is taken up and 
deposited in other structures to which it has an affinity, as 
cartilage, bones, fibrous tissue, forming topha or chalk forma- 
tions, or stones consisting of urate of soda. They are found in 
innumerable situations in chronic gout, in the eyes, ears, heart, 
joints, etc. 

In the gouty diathesis, without local manifestations, are to 
be found neuralgia, dyspepsia, palpitation, syncope, congestion 
of liver, piles, anaemia, pains in head, toothache, tonsillitis and 
asthma ; besides it is a common cause of disease of heart, arteries, 
kidneys, and, indirectly, of apoplexy, etc. Gout presents itself 
in so many different forms that it is often difficult to recognise 
it when we meet with it, and many cases are overlooked because 
the disease is not found in its accustomed seat. 

One patient may suffer from bronchitis, another from psori- 
asis ; one may have gravel, another asthma, or, again, neuralgia 
of the face. One may be alarmed by his having to be treated 
for an apparent gonorrhoea, while another may have piles or 
tenesmus ; all of which are but local exhibitions of the consti- 
tutional affection. 

Treatment. — The general principles of treatment consist in 
perfect rest between blankets, attention to the condition of the 
skin, kidneys and bowels; to the former, warm baths, to the 
latter, with salines, so as to relieve the overloaded heart and 
blood-vessels. For any irritation about the heart, mustard 
applied and to be repeated. The following is to be given at 
repeated intervals, so that the sensorium experiences no sensa- 
tion of pain: 

Pulverized opium, ten grains; Dover's powders, thirty grains ; 
pulverized nitrate of potash, sixty grains. — Mix and make 
twenty powders. Dose, one, as indicated. 

If there is fever, aconite and veratrum viride. To cut short 
an attack, nothing excels the phosphate of quinine in alternation 
with the wine of the root of colchicum. These two remedies 
act quickly and meet the indications most promptly. As to 
the dose, from one to three grains of the quinine every three 
hours, with colchicum enough in alternation to slightly move 
the bowels, the dose necessary being usually from fifteen to 
thirty drops. If the evacuations from the bowels are too frequent 
diminish the quantity, but do not discontinue. 

As soon as the acute stage is over, the same remedies may 



170 DISEASES OF THE BLOOD. 

be continued, although it is often advisable to change to some 
of the following drugs: 

Carbonate or bromide of lithia possesses remarkable medical 
properties, being one of the most soluble salts of uric acid that 
is known. 

Sulphur in alternation with liquor potass is extremely effica- 
cious in dissolving and eliminating the urate of soda. 

Iodide potass is an invariably good remedy. 

Salicylate soda has the remarkable property of preventing 
the formation of urate of soda, and should be given in alter- 
nation with quinine. 

Benzoic acid administered after meals prevents the formation 
of the tophaceous deposits. 

Phosphate of ammonia decomposes the insoluble lithates of 
soda and leads to absorption of them when deposited. 

In chronic gout, or a state nearly allied to gout, or half gout, 
there may be no local inflammation, pain or obvious swellings, 
or the gouty paroxysms, but it works more silently and is 
characterized by the abundance of lithates in the urine. There 
is apt to co-exist signs of ill-assimilation of food, with aches 
and pains, unaccompanied by any perceptible change in the 
aching part. 

A very common and prominent symptom in these cases is 
vertigo, associated with dull headache, occipital pain, occasional 
irregularity of the heart, oppression about the heart, memory 
fails, and an exercise of the mind is laborious. Frequently 
the gastric derangement is not well marked, so that the patient 
is apt to believe that the trouble is all in the head. 

On examination of the urine in these cases, we find the 
lithates in great abundance, urine scanty, highly colored, spe- 
cific gravity greatly increased, and readily deposits urates of a 
pink or brick color, and crystals of uric acid. 

In the treatment of these cases, rest from mental labor, a 
plain, rather spare diet, free exercise in the open air, and the 
Dowels kept regular with salines once a day. The remedy from 
which most satisfactory results are obtained is the wine of the 
root of colchicum, in small doses, barely enough to move the 
bowels. 

The diet in gout should be nutritious, as milk, arrow-root, 
tapioca, fish, oat meal, fruit, vegetables, avoiding animal food 
as much as possible. 

Women are comparatively free from gout. This immunity 
is due to sexual causes, the character of her nervous system, 
and the rudimentary condition of her great sympathetic. A 
gouty, bald-headed woman may be said to have left her sex, cast 
off the woman and become the man. 

Among males, whose nervous systems are exhausted by any 



DISEASES OF THE BLOOD. 171 

kind of drain, or worry, or study, the gouty diathesis is very 
prevalent, and it lies at the basis of nearly all cases of Bright 's 
disease of the kidneys. 

RHEUMATOID ARTHRITIS. 

A chronic inflammation of joints, with elements of both gout 
and rheumatism. Causes are the same as laid down under 
gout and rheumatism — a combination of the two conditions. 

The ordinary symptoms are pain, swelling and stiffness of 
affected joints. If the case is acute, it may come on quickly, 
with rigors, fever and general disturbance; but usually the 
affection is chronic, commencing with languor, restlessness, 
irritability and vitiated secretions. The joints become stiff and 
painful; effusion into the synovial membranes causes them to 
appear swollen and distended, while the limbs generally waste; 
and if the hip, knee or ankle be the parts affected, there is 
lameness. Fluctuation can sometimes be detected, or a distinct 
kind of crepitus may be felt, a peculiar cracking of the joints 
on movement is often observed. If the disease has lasted some 
time there may be thickening of the articular covering, equal 
to bony anchylosis, or there may be a general wasting of the 
cartilages. In addition there is deformity of the articulations, 
spasm and neuralgia; besides, mental depression, dyspepsia, 
acidity, rest at night disturbed, affected by changes in the 
weather. 

In the treatment the general health must be improved. All 
the emunctories of the body regulated. The diet is to be 
generous, vitalizing, warm clothing and best attention possible. 

A general tonic and alterative course, among the former, phos- 
phate of quinine, minerals, acids, cinchona; among the latter, 
sulphur, iodide of potash, colchicum locally, general warmth. 

HJEMATOZOA. 

The following entozoa have been found in the human blood : 

Filaria Sanguinis Hominis.— A worm of microscopic dimen- 
sions fouud in human blood in sufferers from chyluria. 

Distoma Haematorum. — An entozoa with a flat elongated 
body and a cylindrical tail ; inhabits the portal vein and the 
veins of the mesentery, liver, kidneys, bladder and intestines, 
gives rise to the haematura of our Southern intermittent. 

Hexathyridium Venarum. — About three lines in length. 
Is often found in the venous blood of consumptives and in the 
sputa of patients affected with that disease if streaked with 
blood. 

Fasciola Hepatica. — The fluke is found most frequently in 
the portal vein and gall-duct; often passed in innumerable 
quantities by the bowels. 



172 DISEASES OF THE BLOOD. 

HYDROPHOBIA. 

The living germ of rabies is communicated to man by the 
inoculation of the saliva of a rabid animal. Period of latency 
or dormancy of the germ varies with the grade of vital force. 
With strong vital force it may remain quiescent indefinitely, 
whereas, in a weak and impaired constitution the germ may 
take on vigorous growth and use up vital force in a few days. 

In the dog, there can be little doubt but that the degradation 
of living matter which gives us the germ rabies, may be due to 
filth, want of natural grasses and water, over-exhaustion, heat, 
and probably from other animals. The fact that a dog only 
perspires by its mouth may have something to do with it, in 
rendering it more obnoxious to its development. Licking the 
hand, bites, scratches are the ordinary forms of inoculation. 
As a latent germ or slightly active one in the human blood, it 
gives rise to a number of obscure nervous affections, as epilepsy, 
asthma, neuralgia, hysteria, special conditions of irritation of 
the brain, chiefly around the pons, spinal cord and great sym- 
pathetic. 

If the germ becomes active, or, in other words, if hydrophobia 
is about to appear, there is great nervousness and irritability, 
a mental condition of profound despair, haggard appearance 
of countenance. If from an old bite or inoculation, the cicatrix 
becomes painful, sharp lancing pains radiate along the course 
of the nerves up the limb, and in a freshly bitten part the 
same sensations. Slight spasms come on, very light at first, 
and long intervals between, but they gradually become more 
violent, increase in length, and the interval between grows less 
and less with each occurrence. During these attacks the features 
become livid or purple, eyes protrude from their sockets ; thick, 
viscid, ropy saliva is secreted, which keeps him constantly 
hawking and spitting ; spasmodic action of the muscles of the 
throat and pharynx and diaphragm, and latterly, of the entire 
body. During these paroxysms the patient is wild and delirious. 
In the interval between, nervous impressibility is intense, thus, 
dread of movement so great that even the moving of a curtain 
or door, the undulation of water in a glass, will excite a spasm. 
Still, there is a real dread of fluids. They are more difficult to 
swallow than solids, as they bring all the rings of the oesophagus 
into active exercise. Great delirium, violent spasm, exhaustion, 
death. 

It is a disease that is easily recognized by the great mental 
irritability, by a total absence of fever, by the character of the 
spasm, very light at first with long intervals, by the fits gradu- 
ally becoming longer and more violent, with less time between ; 
the face, during paroxysm, livid or purple, eyes protruding, 



DISEASES OF THE BLOOD. 173 

hawking and spitting thick viscid saliva ; while paroxysm is off, 
conscious. 

Treatment. — After a bite ligate above the wound, then 
resort to free incision into it or apply wet cups over it ; encourage 
free bleeding with fomentations of hot water ; then either cau- 
terize the wound freely with caustic potash or wood ashes, or 
if none of these are hand} T , chop a number of red onions very 
fine, and crush or beat into them pulverized muriate of ammonia, 
and apply for several hours ; if a large wound, fresh application 
every hour, then poultice with lobelia and slippery elm. At once 
the patient should be placed on small doses of lobelia, and if 
indications of a spasm, larger doses, just enough to nauseate 
well, not to vomit. Keep on with it several days. Lobelia has 
a retrograding action on the germ rabies ; it will not cure, but 
prevents its activity and development. The living germ will 
only die under a condition of quasi-suspension of the nervous 
system. This is to be obtained if commenced early, when the 
patient can swallow freely, by very large doses of fluid extract 
of sumbul, a strong infusion of scullcap and sesqui-carbonate 
of ammonia. Administer often ; repeat one after the other in 
as large a dose as the stomach will tolerate, and no let up until 
a condition resembling general paralysis is induced, with a sleep 
like coma. 

If this condition can be brought about the germ will die. 
The rate of growth of the germ rabies is determined solely by 
the debility of the affected person, and there is no way left, no 
time for anything but cutting off the pabulum by partially sus- 
pending nerve force. The power of growth is great, but if this 
quasi-suspension is induced, there seems to be no nutrient matter 
for the germ. It must be performed early. None of the remedies 
are in any way poisonous, so there is no danger from an over 
dose ; and there must be no stopping until the most profound 
anaesthesia is produced. Never be satisfied with a sensation of 
pins and needles over the entire body, that feeling must be 
followed by profound narcotism. Anaesthetics, chloral hydrate, 
opium, bromide of potass, are no good, neither are the general 
run of acro-narcotics, as aconite, belladonna. 

The passion of rage in any animal, even man, evolves a 
special living principle, a disease germ ; for the bite of an angry 
man, free from the anaesthetic influence of alcohol, is highly 
dangerous and often fatal, causing bacterial poisoning, erysipe- 
latous inflammation of cellular tissue, and death. 

The principle might be carried further. Are not there living 
principles in all our emotions, desires, affections, passions, which 
render them contagious? Have we not special epidemics which 
are catching, religious excitement, suicidal mania, seasons when 
special crimes seem to be propagated ? 



174 DISEASES OF THE BLOOD. 



GLANDERS. 

A malignant, contagious, germinal disease, due to a degra- 
dation of normal living matter of the lining or Schneiderian 
membrane of the nasal organs of the horse, ass, mule, and the 
alteration that takes place is into a giant form of amoeba, pre- 
cisely analagous to catarrh in the human subject, the only 
difference being in the size of the germ. In the horse the disease- 
germ or micro-organism is quite large, whereas, in the catarrh 
incidental to man it is very small. The giant amoeba of our 
domestic animals is most malignant, and in glanders, so called, 
they form colonies in round scooped-out ulcers, with a red granu- 
lation in the centre, the muco-purulent discharge being very 
abundant, thick, ropy, foetid and loaded with germs. Glanders 
and farcy are identical. In the former we have the germ in 
the nose working inwards to the blood; in the latter it has 
entered the blood and is growing in the lymphatics. In farcy, 
with engorgement of the lymphatic system, the blood process 
of formation is seriously impaired, and we are apt to have 
haemorrhage in the cornea and other structures of the eye, 
giving us what is termed pink eyes. 

The predisposing cause of glanders in animals is depressed 
nervous and physical energy, such as is produced by hard work, 
overcrowding, isolation, sameness of diet, exposure to air cur- 
rents, privation, depressed and vitiated states of the atmosjjhere, 
endemic conditions, air loaded with germs, abnormal metereo- 
logical states, dispersion of germs over large areas, very fatal 
to man and animals, destroying the red discs of the blood and 
is death to that fluid ; besides, it causes immense hypertrophy 
of spleen, starchy degeneration of liver and kidneys and general 
dropsy. 

Like all germ diseases, it is propagated by contagion and 
infection. It is very prevalent in all sections of the country, 
and it exists to such an alarming extent that it is becoming a 
serious and growing evil. It makes occasional epidemic attacks 
under a form named epizooty. 

The gathering together of several hundred horses in one stable 
is not conducive to their health, and when the slightest catarrhal 
condition is present, likely to be disseminated. It is well known 
that the disease-germs are not only abundant in the nasal dis- 
charge, but that the breath, sweat, urine and other excreta are 
loaded ; and where have we the least sanitary arrangements 
made for its suppression ? In the stalls, blankets, feed boxes, water 
troughs there is the living contagion. The public drinking 
troughs are a source of danger to animals, as the germs pass 
into the water and the glandered horses are allowed to quench 
their thirst at those valuable conveniences. In the act of drink- 



DISEASES OF THE BLOOD. 175 

ing by the horse, a certain amount of saliva and nasal discharge 
always escapes into the trough, so that one glandered horse may 
infect all that drink subsequently from the same trough ; for, 
although the discharge is heavier than water, and as we would 
naturally suppose, sink to the bottom, the fact of its being alive 
and the germ growth increased by water, myriads and millions 
are grown light enough not only to float in the water, but also 
to float through the air. 

In the treatment of glanders in the horse we use the ozonized 
catarrh fluid, same as in the human subject. Warm drinks of 
flaxseed tea with sulphite of soda ; food, the grain from a 
brewery and brewers' yeast. All enlarged lymphatics to be 
opened and dressed with charcoal and yeast poultices, and a 
free use of permanganate potass as a wash. Besides the destruc- 
tion of the germ in nasal cavity and blood, quarantine, thorough 
ventilation, a liberal use of lime and disinfectants, with a liberal 
supply of good warm food, avoidance of overwork and all insani- 
tary conditions. 

In man it is a malignant and contagious disease, due to the 
germ from the horse, with same condition of nose and lym- 
phatics. Usually rigors and a fever. 

The presence of the disease-germ glanders in the blood, either 
in the horse or the human subject, gives rise to acute starchy 
degeneration of the, spleen, liver, kidneys and lymph canals, 
which speedily produces the white cell disease, dropsy, and death. 

Treatment is on general principles. Control fever, give sup- 
port, douche out the nostrils daily with antiseptics ; administer 
same class of remedies internally, as salicylate of soda, sulphuric 
acid, sulphite of soda, thrice daily, in alternation with quinia 
and aromatic sulphuric acid. Pure air, all enlarged lymphatics 
to be at once opened and dressed with antiseptics. 

The Epizooty, the epidemic form of glanders, is due to insani- 
tary states existing in stables, to overcrowding, to a sameness 
or meagre or insufficient food. 

Pink Eye is simply the same disease germ colonizing in the 
eye instead of the nose or lymphatics. 

BITES OF RABID ANIMALS AND VENOMOUS 
REPTILES. 

The poison of venomous reptiles and rabid animals is a living 
germ which has a strong affinity either to destroy the blood or 
nervous system. In the former, erysipelatous inflammation is 
predominant; in the latter, a peculiar train of nervous symp- 
toms, as pain in the wound radiating in the course of the 
nerves; faintness, rapidity and feebleness of pulse; bilious 
vomitings, difficulty of breathing, profuse cold sweats, jaundice, 
convulsions. 



176 DISEASES OF THE BLOOD. 

All bites of rabid animals are nearly treated alike, a ligature 
above the wounded part to prevent the germs being carried 
into the blood or nervous system, incisions, wet cups, hot fomen- 
tations to encourage free bleeding, wood ashes or caustic potassa 
applied freely; then irrigation with vinegar, followed by muriate 
of ammonia, either as a lotion or in a poultice. 

To all bites of venomous insects, as wasps, musquitos, spiders, 
and poisoning with ivy, sumach and other agents, a saturated 
solution of muriate of ammonia is sufficient, if kept constantly 
moist, to neutralize the poison. 

In the case of bites by rabid animals producing erysipelatous 
inflammation, the germs lodge in cellular tissue and blood, 
involving the nearest lymphatics, and causing abscess, doughy 
swellings in the body, and death at a remote period. 

In cases of this kind free incisions and antiseptic poultices. 

In another class of cases the germ of the reptile or snake 
becomes imbedded in a nerve or its neurilemma, and grows 
with great rapidity, so prodigious that the germ development 
may cause death in twenty minutes, the entire nervous system 
becoming perfectly paralyzed, the cutaneous surface shrunk and 
withered and as white as snow, constriction of chest, threatened 
paralysis of the involuntary muscles often taking place a few 
minutes after the bite. In all such cases there is no time to 
wait on the action of drugs, and the quickest and safest plan 
is to procure anaesthesia of the nervous system for ten or twelve 
hours by the copious drinking of good brandy or whisky until 
perfectly drunk. It must be given in half pint doses every few 
minutes to obtain the desired result. It is most extraordinary 
the quantity necessary to be given in some cases. During the 
quasi-suspension under whisky there seems to be no pabulum 
for the germ elaborated, and it dies in the body, the bitten person 
recovering from his anaesthesia or stupor well. 

A still more certain method is to combine liquor potass with 
the brandy or whisky. The liquor potass completely neutralizes 
snake poison. It should be given in the brandy in ten, twenty 
or thirty drop doses sufficiently often. The brandy stimulates, 
rouses, carries the potash into the blood, and enables it to over- 
take and neutralize the poison in the blood. The saturation of 
the system with the alkali until the secretions are alkaline is 
the point to be aimed at. The permanganate of potassa has 
the same power, but owes its property to the potash alone. 

POISON OF SUBJECTS. 

In all deviations from health a change takes place in the 
living matter of man and animals. This change is simply a 
degradation of healthy matter into disease germs, as bacteria, 
amoeba, vibrios, oidium albicans, tubercle cancer and syphilitic 



DISEASES OF THE BLOOD. J 77 

and other germs. When the sonl element leaves or life ceases 
these germs become active ; their rate of growth is incompre- 
hensible, and in a short time they reduce our bodies to simple 
materials, to their original constituents, water, carbonic acid, 
ammonia and earth. During this transition of change or death 
a great variety of complex or dual or quadruple germs are 
liable to be formed, which, if introduced into the living blood 
of man, have their minute property of vitality augmented, and 
will produce in the living organism the same state of decompo- 
sition as they were carrying out in the death. The olfactory 
nerve recognizes them as gaseous emanations, or faint, sickly, 
nauseous odors, but in those an experienced and educated phy- 
sician recognizes the odor of the bacteria, vibrios, oidium albi- 
cans, etc., etc., living poisons, micro-organisms which find their 
way into the bodies of the living by the eyes, nose, mouth, skin, 
and if they enter the blood they will grow, but if the dissector 
is healthy they may go in and pass out without any alteration 
of their organic properties. Their passage by the bowels is the 
cause of the gastro-intestinal irritation so common among 
medical students. 

Dissection Wounds. — The more highly organized the flesh 
or individual, the more rapid is a change into germ elements. 
We see this in all animal matter. How quickly the tender loin 
changes compared to other parts! All human subjects are but 
a mass of germ matter, being more or less virulent, according 
to the disease or species of germs under which the individual 
died. Injecting the subject with chloride of zinc, or arseniate 
of soda, or oil of cloves does not destroy the germs; they 
simply arrest their activity. There is no known antiseptic, 
unless it is the salicylate of soda, that can destroy the germ of 
small-pox, anthrax or Asiatic cholera in the dead — nothing 
but cremation. The bacteria of erysipelas or bacteria vibro of 
puerperal fever is also tenacious of life; so is the oidium albi- 
cans of spotted fever, diphtheria and malignant scarlet fever, as 
well as the germ-svphilis and cancer. 

The worst consequences of wounds, scratches or abrasions 
being inoculated with a germinal poison from a subject are, 
inflammation of veins, the blood in which becomes a living 
mass of bacteria; diffuse inflammation of skin, cellular tissue, 
with engorgement of the lymphatics; together with languor, 
lassitude, debility, rigors, vomiting, pulse frequent and sharp, 
tongue heavily coated and dry, great restlessness. In other cases 
the vital forces are better; a pustule may form on cut or abrasion, 
excruciating pain running to shoulder of affected side, with full- 
ness in axilla and neck, and doughy swelling on one side of 
the body, which soon assumes an erysipelatous redness. The 
symptoms become aggravated, breathing difficult, pulse quicker 

23 



178 DISEASES OF THE BLOOD. 

and quicker, the tongue dry, brown, tremulous; great mental dis- 
tress, countenance haggard, delirium, skin yellow, soon ushered 
in with death. In other cases, the patient dies early, either 
before or during the precursory fever. 

Treatment. — In all cases attend to the wound, which excise 
or cause it to bleed freely, cauterize with caustic potassa, neu- 
tralize with vinegar, or lotions of muriate of ammonia may be 
sufficient. If veins are red, cordy and extremely painful, apply 
a row of leeches along them and then the muriate of ammonia 
solution during the day and alkaline poultices at night, with 
abundance of opium to keep down pain. 

Administer an emetic of lobelia, open the bowels freely with 
cholagogue remedies, and alcoholic vapor-bath and general 
treatment for fever, as aconite, veratrum viride, etc., nourishing 
diet, irritation to be allayed ; and now the life of the patient 
depends upon the persistent, steady administration of antiseptics, 
such as are laid down under the head of typhoid fever. 

Nurses, attendants and washerwoman should be cautioned, 
indeed, all clothes and all about the patient should be disinfected. 

HEMORRHAGIC DIATHESIS. 

This is a peculiar constitutional defect and consists of a want 
of fibrin in the blood, which gives that fluid a want of cohesion, 
so that the slightest wound bleeds freely and an oozing is liable 
to take place from mucous membranes on very slight irritation, 
hence, haemorrhages from nose, bronchi, stomach, kidneys, 
uterus. This fluid condition of the blood, irrespective of any 
disease, seems to depend upon some constitutional defect ; patients 
of light hair, white skin and a highly sanguine temperament 
are its victims. 

It may be either hereditary or acquired. It may be suspected 
if there are haemorrhages or ecchymosis with debility. 

The treatment to overcome it is good diet, mineral acids, cin- 
chona, etc., and all surgical operations on this class of subjects 
must be very carefully guarded. 

FATTY AND AMYLOID DEGENERATION. 

Chronic disease, intemperance, residence in a tropical climate, 
malaria and certain drugs — everything that retards the decar- 
bonizing function of the liver, may give rise to the presence of 
oil globules in almost any tissue of the body ; on muscular 
structure, if unused or overworked. The muscular fibres of the 
uterus are often usurped by it, even the coats of arteries. In 
all persons who use alcohol in any form fatty tissue takes the 
place of healthy structure. The causes of fatty degeneration 
are apparent. 

Amyloid or starchy degeneration is very prevalent, but its 



DISEASES OF THE BLOOD 179 

causes are much more obscure than the former. It has been 
found in the liver, kidneys, spleen, pancreas and other glands 
and structures, its properties being analogous to real vegetable 
starch. Whatever the particular substance may be, the fact 
exists that we have a remarkable constitutional disease which 
invades several organs at the same time, and renders them inca- 
pable of performing their functions. 

Patients affected with amyloid degeneration gradually assume 
a cachectic broken-down appearance, lose flesh and strength, 
dropsy often supervenes, urine becomes albuminous if the kid- 
neys are affected. 

When the liver, spleen or kidneys are affected, it may be 
difficult during life to say which is which, although the use or 
prior use of alcohol will invariably decide in favor of fat; 
whereas a tubercular cachexia will naturally lead us to starchy. 

The point may not be determined till after death, when they 
are easily distinguished. Both may cause atrophy as well as 
enlargement of glands. 

CALCAREOUS OR MINERAL DEGENERATION. 

Every texture of the body, every gland or organ, is liable to 
earthy degeneration. 

The causes are somewhat obscure, but it seems to be closely 
blended with a nervous temperament, tubercular and cancerous 
diathesis, as we find this deposit most generally among that 
class of persons. 

It is important to distinguish between ossification and calci- 
fication. A deposit of bony matter may take place and be even 
covered with periosteum, and become either a spongy or hard 
cancellated body ; whereas, when living or calcareous degenera- 
tion takes place, it gives rise to calcification or petrifaction. 

The valves of the heart, the coats of arteries, sinuses of the 
brain are often found brittle from that cause. In some cases 
earthy matter is found in the cellular tissue, liver, kidneys, 
bladder, brain, and is classified under the head of a phosphatic 
diathesis, which is common in the nervous temperament. — (See 
Phosphatic Diathesis.) 

MERCURIAL POISONING. 

The use of mercury in the arts leads to a vast amount of 
disease. Makers of barometers, thermometers, looking-glasses 
are thoroughly saturated with mercury. The amalgam used 
by dentists contains a large per cent, of pure quicksilver, which 
breeds the disease in those who have their cavities filled. The 
finer the prepartion or trituration, the more likely is it to do its 
deadly work. There is less danger of absorption from a blue 
pill, followed by a saline purge, than from the infinitesimal 



180 DISEASES OF THE BLOOD. 

trituration of the empiric mercury that may find its way into 
the human organism by the skin, breath, salivary glands of 
the mouth and stomach. Its use, as a medicine, is now very 
limited. The old doctors have found out its destructive action 
on the blood and use it little, but in the sugar pellets and 
powders it is the leading drug. It enters the blood, produces 
impoverishment of that fluid by the direct action of the metal 
on the red globules; then it causes chronic inflammation of the 
liver, mercurial aphthse, stomatitis and destruction of mucous 
membrane, especially of the throat, and causes inflammation, 
thickening and necrosis of bones. It stamps its victims with 
a peculiar metallic color, gives a peculiar fcetor to the breath, 
and is destructive to all the vital organs of the body. It may 
destroy the germ syphilis, but it will be at the expense of creating 
a mercurial cachexia and a living barometer of its victims. 
This is unnecessary when we have very superior drugs to do 
the work. 

So long as no organic change has taken place in the liver or 
bones from the action of mercury, iodide of potass will unite 
with it and cause its free elimination; so the treatment of 
mercurial poison resolves itself into the one drug, with sul- 
phuret of potassium baths, and tonics with good diet. 

PHOSPHORUS DISEASE. 

While we strongly c advocate the use of a diet containing more 
brain and bone elements, as oatmeal porridge and cream, boiled 
white fish, corn meal without baking powders, and flour not 
deprived of its phosphates, as being more conducive to health 
and longevity, and to an increase of intellectual power, — that 
we believe, in those natural forms, that phosphorus does give 
thought and depth to mental vigor, still, we must say, in all 
candor, that the remedy phosphorus, as isolated, is a deadly 
poison to a large number of our people, and ignorant, so-called 
doctors, prescribe it indiscriminately. No man or woman who 
uses either tobacco or alcohol should ever take phosphorus in 
any form, for if the} 7 do, it will irritate their stomachs and cause 
acute or chronic gastritis. It tends, also, to cause fatty degenera- 
tion of the substance of the heart, liver, kidneys, spleen and 
uterus. 

The operatives in phosphorus, in match factories, rat poisons, 
etc., inhale its fumes, and its first action is to cause progressive 
anaemia, with loss of hair and great debility. Its second action 
is to produce necrosis of the bones, a dropping out of the teeth 
and breaking down of the jaw. Now there can be little doubt 
that the excess of phosphates in the blood in those cases destroys 
the bone lymph, and the death of the jaw and other bones is 
due simply to starvation, to the destruction of the bone elements. 



DISEASES OF THE BLOOD. 181 

This may be due to the direct action of the metal on the blood 
and also to impairment of sanguinification through disordered 
innervation. 

The only treatment is to change the occupation of the patient, 
sea air, a very generous diet and vegetable tonics. There is no 
known remedy to antidote its effects. We seriously caution 
our readers to be on their guard against this deadly and destruc- 
tive drug. 

BRASS FOUNDERS' DISEASE. 

Operatives in copper, zinc and tin are liable to several morbid 
conditions from the inhalation and absorption of the fumes of 
the metals. Most generally the metal has an affinity for the 
fine delicate nerves of the duodenum and brain, like lead and 
bismuth, but workers in brass have a regular cachexia produced 
by the metal, a feeling of languor and depression, or peculiar 
sallow hue of skin, with anaemia, and febrile attacks like inter- 
mittent fever. 

The attacks, however, do not come on with regularity. In 
the stage of chill there is usually constriction or tightness about 
the chest, and in the last stage, which is followed by a profuse 
sweat, the linen is usually stained with the eliminated metal 
and it has a brassy odor. 

Poisoning by brass and tin is much more common than is 
generally supposed. Many of the indescribable derangements 
of the digestive tract are due to minute portions of those metals 
finding their way there from various culinary articles, as ket- 
tles, pots, &c, and also from the cocks and spigots of soda foun- 
tains, mineral-water bottles, and ordinary water-pipes. An 
oxalate of tin is to be found in every article preserved in tin 
cans, as tomatoes, peas, asparagus, which is exceedingly toxi- 
cal and capable of producing a well-marked train of symptoms, 
identical in their character with brass poisoning. The preserv- 
ation and cooking of edibles in tin and brass vessels is a pro- 
lific source of disease, and measures of some kind should be 
adopted to arrest the spread of this latent form of poisoning. 

Treatment. — Workmen should avoid the fumes of zinc and 
brass; iodide potass unites with them freely and causes their 
elimination. In some cases lobelia emetics are of great efficacy, 
followed with cinchona and mineral acids; bowels to be regu- 
lated and alkaline baths used daily. 



24 



182 DISEASES OF THE NERVOUS SYSTEM. 



DISEASES OF THE NERVOUS SYSTEM 



VERTIGO. 

Vertigo, a swimming in the head ; muscse volitantes, specks or 
spots before the eyes ; and tinnitus aurium, noises or ringing in 
the ears, are respectively due to exhaustion of the cerebral pulp 
associated either with congestion or anaemia. Vertigo, a transi- 
tory state of giddiness, a whirling or falling, surrounding 
objects appearing to be in motion, is often followed by head- 
ache, nausea. It is a symptom of a devitalized state of the 
brain, weakness or general disease of the blood, or it may be 
due to a poison, as opium or tobacco, or alcohol ; or of some 
auditory, cardiac, gastric, intestinal or hepatic affection. Any 
want of equilibrium will give rise to it. It is often a precursor 
of apoplexy and paralysis. In aged persons it is often due to 
disease of the cerebral arteries. Vertigo is the most common 
of all morbid states of the brain, and its great frequency must 
be accounted for irrespective of disease or poisons. 

It has long been known that the nervo- vital fluid within the 
skull forms a bed-plate upon which the brain rests; that this 
watery fluid within the ventricles finds entry and exit from the 
brain into the spinal column, so that it comes and goes from 
spine to brain according as the pressure of blood is less or more. 

The mechanism by which the human frame is adapted to go 
upright is unnecessary to discuss. It will not do to say that 
it was the size of his brain and ambition that gave him this 
nervous energy to brace up or take the trouble to be upright. 
True, the increased size of man's brain and its peculiar richness 
in grey matter necessitates an increased supply of rich blood. 
The erect posture placed the brain aloft, so that blood supply 
is difficult, but this is guarded against and regulated by the 
cerebro-spinal fluid. Three ounces of fluid is a small quantity; 
still, the circulation of blood in the cranium is subject to small 
changes. In extravasation in apoplexy the amount of blood 
seldom exceeds three ounces; there is no room for more, for 
that corresponds with the amount of cerebro-spinal fluid. 

In the recumbent posture, the entire spinal fluid is within the 
skull, which slows the heart ten to fourteen beats per minute. 
When the body is raised and the venous blood flows away readily 
from the brain, the cerebro-spinal fluid may outstrip the arterial 



DISEASES OF THE NERVOUS SYSTEM. 183 

blood in the race to supply its place, and thus the ventricles of 
the brain may fill up with water more quickly than its substance 
with blood, and so the brain blanches and the person feels giddy. 
In the anaemia of exhaustion the ventricles have an increased 
capacity, and many persons, with feeble circulation, experience 
giddiness, a sense of insecurity. Besides these there are numerous 
other conditions that render vertigo more common than the 
other two symptoms. 

The immense size of the human brain, and its extreme rich- 
ness in grey matter, (weighing from forty -five to sixty-five 
ounces,) necessitates a great demand for phosphates, which, if 
not very abundant in human food, gives rise to a condition of 
starved brain, of which vertigo is the only symptom. This is 
common in brain-workers who neglect a phosphatic diet. 

HEADACHE. 

Is another symptom of an enfeebled brain, and is common 
among those who suffer the wear and tear of highly civilized 
life. 

There are several varieties: 

Organic Headache, clue to disease of the brain or its mem- 
branes, accompanied with vertigo, musca? volitantes, tinnitus 
aurium, vomiting, convulsions ; character of pain will depend 
on whether it be the membranes or brain substance that is 
affected; if membranes, sharp or lancinating ; if substance, dull. 
When due to inflammation, pain aggravated by noise, light, 
heat, motion. It may be due to the invasion of syphilitic or 
cancer or other germs or parasites. 

Congestive Headache is due to inherent weakness in brain 
substance and a determination of blood. There are symptoms 
of plethora, vertigo, beating in ears, caused by over-stimulation, 
or it might arise from a sudden suppression of the catamenia. 

Bilious Headache, due to derangement of the stomach, 
bowels, liver. Tongue coated, breath foul, flatulence, low spirits, 
nausea ; liver very torpid, constipation, stools clay-colored ; passes 
off with removal of cause. 

Nervous Headache is due to debility, exhaustion, poor blood, 
haemorrhage, over-lactation. Irritation reflected, it may assume 
an intermittent type. When hysterical women suffer from this 
form it is usually confined to a single spot, and resembles the 
driving of a nail into the part, and is known as the clavus 
hystericus. 

In the treatment of headache, general principles must be 
observed. Bowels regulated, skin stimulated, rest inculcated 
and the cause removed. In the organic form, hyosciamus must 
be given same as in acute inflammation of the brain ; in the con- 
gestive, purgatives, warm mustard food, baths, removal of cause; 



184 DISEASES OF THE NERVOUS SYSTEM. 

in the nervous, nutrition, tonics, removal of cause ; in bilious, 
cholagogues. 

In all cases the pain must be relieved, because brain-pain is 
out of all proportion to that of any other form. For this purpose 
the following remedies have been found of great utility in all 
forms, (except opium, chloral hydrate and bromide of potass as 
deleterious drugs): 

Citrate of caffeine, in all forms of sick headache, is of great 
efficacy. The dose is small — two to three grains, repeated every 
half hour until the headache disappears. There is no failure — 
it is a powerful remedy. Given just adapted to the needs of 
the sufferer, it quickly and perfectly removes the pain in the 
head and nausea. The use of caffeine in headache is one of 
the most important of special remedies. The relief it gives is 
solid and speedy. It deserves to rank high. It is often preferable 
to guarana, being more sure and speedy and more congenial to 
the stomach. Give it either before or during an attack. 

Guarana has the property of relieving all forms of sick head- 
ache, but should be given when the headache is approaching 
or even during its attack, and repeated as indicated. 

SLEEPLESSNESS. 

Is often an early and premonitory symptom of disease of the 
brain. It may be caused by passion, mental anxiety, dyspepsia, 
imperfect action of liver, constipation, disease of heart, preg- 
nancy. It is is often an aggravating symptom of chronic inflam- 
mation of the brain, insanity, mania, chronic alcoholism. 

In its treatment, the removal of cause, mental or physical, 
regulation of secretions, good digestible food, moderate exercise, 
avoidance of all stimulants, abundance of fresh air. 

The medical treatment involves the use of such drugs as 
hyosciamus, camphor, lupulin, and an avoidance, if possible, 
of opium, chloral, or bromide of potass, or hypodermic injections. 
The pulverized extract of hyosciamus with opium has a won- 
derful action in promoting sleep and giving rest to the brain 
when exhausted by worry, and followed during the day with 
the ozonised glycerite of kephaline. 

COMA. 

Deep or sound sleep, or a state of stupor with loss of conscious- 
ness from which the patient is roused with difficulty. In coma 
(heavy sleep) there is not only a loss of perception and volition, 
but usually stertorous breathing, flaccid limbs, dilated pupils; 
patient cannot be roused. 

There are several forms or varieties : 

Alcoholic Coma. — Alcohol is a poison which affects espe- 
cially the brain and liver. In large doses it may destroy life 



DISEASES OF THE NERVOUS SYSTEM. 185 

immediately, so that insensibility is often complete. No stertor, 
pulse frequent, pupils contracted or more often dilated. Tem- 
perature lowered two or three degrees; odor of breath. 

Opium Coma. — Patient can at first be roused, breathing 
slow or stertorous, pulse weak and soft, pupils contracted to 
a pin's point, countenance livid, clammy sweat, temperature 
lowered. 

Uraemic Coma. — Patient can generally be roused, except 
near termination. Uriniferous odor of skin and breath, respira- 
tion not stertorous, pulse variable, temperature lowered. 

Epileptic Coma. — Temporary, and insensibility is rarely 
absolute except during the fit. Patient can be roused. Respira- 
tion natural or suspended. Pulse frequent and full. 

Apoplectic Coma. — That due to extravasation of blood or 
injury. Patient rouses with difficulty or not at all. Respiration 
is stertorous, unless placed on side, often irregular. Pulse full, 
face flushed or pale, temperature up, hemiplegia can be made 
out, pupils dilated or in leison of pons contracted, often squint- 
ing or ptosis. 

There are other forms, chiefly due to the inhalation of noxious 
gases, as coal gas, carbonic acid gas, etc., and non-oxygenation 
or non-seration of blood, as in pneumonia, hanging, drowning, 
etc. ; and the coma of nitrous oxide, ether, chloroform. 

The treatment will have to be varied according to the cause ; 
the history of case of great importance as a guide. The greatest 
care and good judgment is often necessary to form a correct 
diagnosis. 

CEREBRAL INFLAMMATION. 

No class of diseases are so interesting as the various affections 
of the brain. The fact that the brain wears out sooner than it 
used to do under what is termed civilization, and that its health 
and vigor, and even the production of disease in it, depends 
on the development and healthy condition of the great sym- 
pathetic, are highly suggestive. In women, children and all 
races outside of the Caucasian, the absence to a great extent of 
cerebral disease can only be accounted for by the rudimentary 
condition of the sympathetic. The effects of isolation and 
sameness, or monotony in causing contraction of its convolutions, 
thus causing epilepsy and insanity, and the action of blood 
poisons, are also of great moment in reducing the angle of 
longevity of our race. The study of brain diseases is not suf- 
ficiently advanced to enable us to elucidate all the points clearly; 
neither are we yet able to distinguish correctly between inflam- 
mation of the substance of the brain and that of its membranes. 
Indeed, they cannot be really separated, although it has been 
attempted. 



186 DISEASES OF THE NERVOUS SYSTEM. 

Acute Inflammation of the Brain. — A partial death of the 
substance of the brain may depend upon two general conditions. 
It may be due to causes within the body, such as depressing emo- 
tions, desires, affections, passions, the struggle for existence or 
excessive mental strain, religious excitement, blood poisons, or it 
may be due to blows, falls, shocks, concussion of the brain or frac- 
ture of the skull. In the former case it is said to be idiopathic ; in 
the latter, traumatic. As brain substance is intrinsically the 
most valuable tissue in the body, it is the most difficult to 
depress and the hardest to establish a renewal of life in; so that 
in the idiopathic form, the stage of shock or incubation is often 
for a number of years, and in the traumatic form, quite a good 
while ; even in bad fracture, with compression, a week or more 
often elapses before active symptoms of inflammation set in. 

After the brain has received the shock, there is then an inter- 
vening period before the rigor and active inflammation, and 
during that time the patient is irritable, restless, peevish, sleep- 
less, complains of heats and colds, burning in the skin, secretions 
are arrested, great lassitude, peculiar idiosyncrasies, great dis- 
turbance of the mental faculties, and there is a characteristic 
pain in the head, usually frontal, aggravated by noise, light, 
heat and motion. There is also intolerance of light, slow pulse, 
want of appetite, tongue dry with white and brown coat, skin 
white. 

These premonitory symptoms become more intense daily, 
when, if the inflammation is about to take place, the patient is 
seized with the most violent rigors and a high fever; pulse hard 
and frequent, strong pulsations of the carotid and temporal 
arteries, headache intolerable and throbbing, eyes suffused, face 
congested, tongue dry and brown, bowels obstinately consti- 
pated, stomach rejects everything, secretion and excretion 
arrested; besides,, there is apt to be violent delirium, coma, con- 
vulsions, paralysis, pupils contracted to a pin's point, articulation 
difficult or indistinct. If not relieved at this point, then pupils 
become dilated, the eyelids drop, (ptosis or squinting) or paralysis 
of muscles of eyelids, frequent twitching of muscles, ghastly 
countenance, sordes on gums and teeth, cold sweats, relaxation 
of sphincters, convulsive paroxysms, paralysis, profound coma, 
which usually soon ends in death. 

In some cases, the first symptom of an attack is convulsions, 
preceded by very slight premonitory symptoms, that are often 
unnoticed. Convulsions, long and severe, may be followed by 
coma, which is soon fatal ; or it may recur frequently at short 
intervals, and pass into coma at the end of twenty-four hours. 
When nausea and vomiting are the earliest symptoms, inflam- 
mation has its origination in the cerebral pulp. When attacks 
begin with convulsions, the affection has started from the arach- 



DISEASES OF THE NERVOUS SYSTEM. 187 

noicl or pia mater ; or, to be more explicit, if the inflammation 
involves the cortical substance and membranes, early derange- 
ment of the intellectual faculties, irritability, constant agitation ; 
if the medullary substance, chills, headache, convulsions, great 
lassitude. 

The medullary substance of the brain is merely the passive 
servant of the cineritious substance, the conductor of its demands 
to the muscles. The grey presides over intellect; the white, 
over movements. 

Rigors taking place during the active inflammatory stage, 
with squinting or dropping of the eyelids, palsy, contraction of 
one pupil and dilatation of the other, indicate extravasation of 
blood into the brain and an unfavorable termination. Acute 
inflammation of the brain may terminate in any of the ordinary 
results of inflammation, but its common termination is effusion 
of blood or extravasation of blood on or in its substance or 
recovery by the slow process of chronic inflammation. The 
haemorrhage is termed red ramollissement. 

In the recognition of acute inflammation of the brain, its 
history, all the symptoms prior to and after rigor, the fever, 
intellectual condition, eyes, face, arrested secretions, and espe- 
cially the headache, must be noted. True, there may exist com- 
plicated phenomena during life, according to what extent the 
various structures are involved, but the leading symptoms are 
a good land-mark. 

Treatment. — At the earliest possible moment energetic treat- 
ment should be resorted to, to aid a renewal of life in the brain. 
For this purpose the patient should be placed in the recumbent 
posture in bed, head and shoulders well elevated, and in an apart- 
ment away from noise, heat, and pretty well darkened; head to 
be shaved and towels kept constantly wet with hot water to be 
wrapped around it. The back and sides of the neck, down the 
back and over the shoulders should be dry cupped ; a roller, 
eight yards long and three inches wide, saturated with mustard 
of the consistency of cream, should be applied from the great 
toes to the knees, wet occasionally with fresh mustard and 
reapplied. Two to three drops of tincture veratrum viricle 
should be given every fifteen or thirty minutes until pulse is 
seventy, and then continued at longer intervals of one, two or 
three hours, as indicated. Free purgation must be resorted to. 
For this purpose, twenty grains of compound powder of jalap 
and senna, with one drop of croton oil rubbed into it, should 
be given, and the same dose repeated every one or two hours, 
or often enough to keep the bowels open twice or three times 
a day — the croton oil to be left out after the third dose. Another 
important indication is sleep. It is very likely the patient 
has not slept for a long time. Then take twenty grains of the 



188 DISEASES OF THE NERVOUS SYSTEM. 

solid English extract of hyosciamus with three grains of pul- 
verized opium, and rub both up in a mortar until a fine powder 
is procured, then add a drachm of sugar of milk; mix well and 
divide into twenty powders, and give one every hour until the 
patient sleeps. If, after three or four are administered, there 
is no sleep, double the dose for three times, and if that fails, 
increase still, but very carefully, never to exceed five to one dose. 
If sleep and a pulse of seventy can be reached, by further good 
management, the patient is safe. On no account resort to chloral 
hydrate, opium, hypodermic injections, as they are totally contra- 
indicated. If arterial sedation and sleep can be procured, still 
persevere for some time with the above. Give little or no diet 
for several weeks; barley or cracker water, oatmeal gruel and 
the like will suffice. 

As the patient improves, other remedies to aid the salutary 
effort of nature may be tried, as bromide of potass, aconite, 
belladonna, lobelia. 

The bromide does good work given in the following manner : 

Camphor water, four ounces; bromide of potass, one ounce; 
bromide of ammonium, two drachms; bicarbonate potassa, three 
drachms. — Mix. Dose, one teaspoonful thrice daily. 

Just as the fever subsides is the best time to commence with 
the aconite and belladonna. A teaspoonful of the tincture of 
each in half a tumblerful of water ; a teaspoonful every one or 
two hours. 

Belladonna, like bromide of potassa, has an anaesthetic action 
upon the cortical substance, the quadrigemina tubercula and 
the membranes which aid in the removal of congestion. It 
will also be found advantageous, in many cases, to alternate 
them with lobelia in full form, as often as every two or three 
hours. Pills of pulverized green lobelia are slower in absorption, 
and less likely to induce nausea. Lobelia is a depressant and 
sedative, has a decided influence in all cerebral engorgements; it 
diminishes respiration, heat, pulse, and abates inflammation. 
With these and other means that the peculiarities of the case 
will suggest, we try to aid nature in controlling inflammation 
of this vital organ. The general principles of treatment of 
fever must be carried out, as to bathing, recumbent posture, heat 
to feet, great quietness, etc., and run the case into one of chronic 
inflammation in which our remedies are more numerous, and 
embrace alteratives and tonics, rest, change of air and a very 
cautious use of food. 

ACUTE SIMPLE MENINGITIS. 

Inflammation of the membranes of the brain may arise in 
children from a very trifling cause, as a blow or fall on the 
head, or extension of disease from the ear or nose, or by exposure 



DISEASES OF THE NERVOUS SYSTEM. 189 

to the sun. The fact that children have only one table in the 
bones of the skull, no middle or cliploetic structure to resist 
shocks, renders them, up to puberty, very susceptible to irritation 
of the membranes from falls or concussions. Independent 
of violence, it may be caused by rheumatism, gout, syphilis, 
tuberculse. 

Symptoms. — The ordinary symptoms of languor, mental 
irritability, sleeplessness, headache aggravated by noise, light, 
heat, motion, intolerance of light, rigors and a fever; pain in 
the head becomes aggravated, irritability increases, delirium, 
frequent flushings of the face, followed by pallor, rapid pulse, 
muscular twitchings, prostration, coma. 

In distinguishing its locality in children observe carefully 
the following : 

Membranes covering the convexity of the brain. — In 
the child, first a rigor, then a convulsion, fever, skin hot, dry ; 
pulse hard and rapid, vomiting, bowels constipated, intense 
headache, aggravated by movement, light, etc., face alternately 
flushed and pallid, eyes injected and staring, noisy and violent 
delirium sets in early, great restlessness, muscular twitching, 
squinting; after three or four days a remission; the pulse fags, 
tongue becomes heavily coated and dry, pupils sluggish, dilated ; 
the delirium passes into coma, and in a few days more intense 
prostration. If treatment be successful, improvement is very 
gradual but progressive. 

Membranes confined to base of brain. — Convulsions at 
commencement, fever, contracted pupils, frequent pulse, clench- 
ing of teeth and retraction of head, coma. In other cases, pain 
in temples, vomiting, constipation, wry neck, loss of appetite, 
a desire for repose; after a few days, vacant look, dejection, 
intelligence clear, pulse and skin natural. Headache unrelieved 
by remedies, coma, death. 

Inflammation of dnra mater. — Often the result of violence, 
of disease of the cranial bones, chronic affections of the ears 
and nose in children, regarded as trifling, may end fatally by 
an extension of morbid action to dura mater. 

Treatment. — In the treatment of this affection in children, 
it must ever be borne in mind that the law of reflex impressi- 
bility is strong in those born of highly civilized parents, so that 
the active measures used in adult cases must be laid aside when 
we have a delicate, impressible child to deal with. We want a 
quiet room, free from noise and heat, and light excluded; no 
cradle; the hair on the head should be cut close and cloths wet 
with either of the following applied : 

Liquor acetate ammonia, one ounce ; alcohol, two ounces ; 
camphor water, eight ounces. — Mix. Or, camphor water, ten 
ounces; muriate of ammonia, one ounce; nitrate of potassa, 



190 DISEASES OF THE NERVOUS 'SYSTEM. 

half an ounce ; chloride of sodium, half an ounce. — Mix. 
Strength varied to age. 

To the feet, dry mustard in socks. Bowels opened gently with 
compound liquorice powder or one or two grains of leptandra 
rubbed up in pulverized liquorice or cascara. To control the 
circulation, tinctures of aconite and belladonna should be given 
in a tea of asclepias, and sleep procured with suitable doses of 
the bromide of potass, as under inflammation in adults, and if 
not powerful enough, give the hyosciamus, but in smaller doses. 
No cupping, blisters, or other counter-irritants on account of 
the reflex impressibility. In case of wandering pains, bryonia is 
often of great value. As soon as the fever is controlled, iodide of 
potass is of great utility, otherwise it must be treated according 
to the cause, taking the greatest care to procure a large amount 
of sleep, if possible ten or twelve hours out of the twenty-four. 
The diet here must be more generous, milk and lime-water, and 
beef tea. Convalescence established upon cinchona and aro- 
matic sulphuric acid, ozone-water, more nutritious food and 
change of air. 

TUBERCULAR MENINGITIS. 

An acute form of inflammation of the brain and its mem- 
branes, with effusion of tubercle from the blood in and on the 
membranes and superficial surface of the brain proper. Common 
among tubercular children under two years of age, and seldom 
met with over that age. 

The predisposing cause is tuber culse. This may be an heredi- 
tary condition in the child, or the child may be entirely free 
from tuberculae at birth but acquire that cachexia by bad food, 
insanitary conditions, drugging with soothing cordials, retarded 
dentition, hence irritation of the gums, stomach, bowels, acidity, 
cholera infantum, etc., which irritation is transmitted to the 
seat of reflex action ; the centres of life are depressed, and in 
consequence normal living matter is changed into the living 
germ tubereulse. 

Cradle-rocking, blows, slaps, falls, jars, shocks are simply 
exciting causes. City life and solar heat act as powerful depres- 
sants, and in some cases the irritation of dentition, cholera 
infantum, burns, etc., are sufficient in themselves to cause tuber- 
culse and give rise to the inflammation. 

It usually comes on slowly and insidiously, marked by debility 
and whiteness of skin, mal-nutrition, loss of flesh and other 
signs of a tubercular diathesis; short dry cough, great peevish- 
ness, restlessness, irritability, attacks of headache aggravated 
by movement, light, noise; giddiness, skin often hot and cold, 
pale or flushed, appetite capricious, tongue furred and breath 
offensive; sickness and constipation, child drowsy, yet restless; 



DISEASES OF THE NERVOUS SYSTEM. 191 

rubs head with band, rolls head in sleep with eyes partially 
open; wakes in alarm and screams, and other warnings of cere- 
bral congestion. These symptoms may last for weeks ; if they 
occur in early summer, before the hot weather sets in, they may 
last the entire season ; if late in the fall, they will disappear on 
the approach of cool weather, or if the patient have proper treat- 
ment applied, it may disappear at any time. 

But suppose the case progresses onwards, all the above symp- 
toms become aggravated and the child lies very quiet, its coun- 
tenance expressive of anxiety and alternately flushed and pale, 
the eyes listless, eyebrows knit, pupils contracted, and is greatly 
annoyed with light and noise; retching, bowels variable. If 
old enough, will complain of head ; often delirium. Fever high, 
pulse, 180, temperature, 107°. After a few days the pulse becomes 
irregular and diminishes, although the slightest exertion will 
cause its increase. Stupor and heaviness may come on, squint- 
ing, patient lies on back, head and heels thrown back, insensible, 
probably picking his nose and lips with tremulous fingers, con- 
vulsions, paralysis, urine and faeces passed involuntarily. 

If there is no effort at recovery, the drowsiness passes into 
profound coma, from which it is impossible to rouse the child. 
Pupils are dilated and insensible, pulse becomes very feeble 
and frequent, extremities become cold, a clammy sweat breaks 
out over the entire body. Paralysis and convulsions follow, 
which soon end the scene. If the case is complicated with 
cholera infantum, these symptoms become modified to a greater 
or less degree by that condition. 

As to its duration little can be said. Some children will 
succumb in two or three weeks; others, again, will struggle on 
the entire summer and finally terminate in hydrocephalus, from 
which they will recover in a few months. 

The growth of tubercle on membranes or brain, carefully 
scraped off after death, seldom amounts to from three to five 
ounces. There is always a great quantity of fluid in ventricles 
and frequently softening of brain substance. 

Treatment. — It is doubtful if any disease requires so much 
care and nice discrimination in management as this. The little 
patient is intensely tubercular, consequently no depleting plan 
of treatment is at all admissible. The child should be kept 
away from noise, light, heat, and not subjected to any movement. 
It should be bathed twice daily, followed by inunction of warm 
olive oil into the entire body; the hair cut, and cloths always 
wet with camphor water, ten ounces ; liquor ammonia acetatis, 
one ounce and a half; alcohol, two ounces. — Mix. Applied to the 
head. Feet encased in stockings with a handful of dry mustard 
in each. The bowels to be regulated either with compound 
liquorice powder or neutralizing mixture with leptandra. The 



192 DISEASES OF THE NERVOUS SYSTEM. 

diet should be mother's milk or milk and lime-water, or juice 
of raw beef extracted, with water acidulated with muriatic acid. 

Tincture of aconite and sweet spirits of nitre should be given 
to control fever. Every source of irritation should, if possible, 
be removed. Scarify the gums if teeth find it difficult to pene- 
trate. If there is cholera infantum, give the proper remedies; 
if great depression of vital powers, stimulants. In all cases the 
best results follow the use of the following : 

Camphor-water, four ounces ; bromide of potassa, one ounce ; 
bromide of ammonia, two drachms ; bicarbonate potassa, three 
drachms ; tincture calabar bean, half an ounce. — Mix. Dose, 
from half to a teaspoonful every three hours. 

There are two points just here that are very difficult to man- 
age, viz : to build up vital force and destroy the germ tubercle 
in the blood. We might very cautiously try one to three grains 
of hypophosphite of potash in a little juice of meat ; or from 
one to five drops of tincture of iodine in sweet milk ; or from 
one to three of iodide of potassa in sweetened water — either 
remedy thrice daily. Other remedies of intrinsic value are 
worthy of a trial, as hypophosphite of lime or soda, or the giy- 
cerite of ozone, ozone-water ; and just as soon as the pain in the 
head is relieved, administer the compound ozonized extract of 
saxifraga with all food-pepsin, as a digestive agent, because it 
is highly antiseptic. Sea air, good, nutritious food, pure milk. 

CHRONIC INFLAMMATION OF THE BRAIN. 

Is a condition in which we have a low grade of irritation. 
It is apt to follow an acute attack, but more frequently it is an 
independent primary disorder. 

Its causes are very various : shocks, jars, concussions, blows, 
falls, railroad traveling, action of the sun, mental strain, worry, 
struggle for existence, study, depressing passions, as grief, sexual 
excesses, whisky, tea, coffee, tobacco, quinine, opium, chloral 
and other drugs; besides, the blood poisons, as rheumatism, 
gout, syphilis, tuberculae, may, with numerous other conditions, 
be enumerated as causes. The vices or defects of civilization 
operate disastrously upon the brain as well as insanitary states 
and diet. 

Its symptoms are much diversified: pain in the head, aggra- 
vated by noise, light, heat, motion, with irritability, restlessness, 
sleeplessness, with heats and colds, with mental depression, dis- 
turbance or idiosyncrasy, pallor or whiteness of the skin, anxious 
expression of countenance, arrested secretions. There is often 
vertigo, specks or spots before the eyes, ringing or noises in the 
ears, unsteadiness of gait, hesitation in speech, stammering, 
stiffness of muscles, loss of appetite, irregularity of pulse, delu- 
sions; subsequently symptoms become more marked; memory 



DISEASES OF THE NERVOUS SYSTEM. 193 

fails, senses become impaired, paralysis, general breaking down 
of health. Its duration is very indefinite and it has a marked 
resemblance to insanity, once fairly established. 

In the treatment we must insist upon rest, freedom from care 
and worry, and an avoidance of all the causes, such as jars, 
mental work, sexual indulgence, the use of tea, coffee, tobacco, 
alcohol, opium. The secretions should be stimulated, bowels 
moved twice daily with mild but efficient remedies, as cascara, 
neutralizing mixture, daily tepid bathing, followed with the 
shower-bath ; hair short, head cool, feet warm. Bitter tonics 
to promote an appetite and ameliorate the more prominent 
symptoms: Sleep should be procured, and, if possible, prolonged 
to ten or twelve hours in the twenty-four, by the repeated and 
persistent use of hyosciamus, thus : 

Solid extract hyosciamus, English, thirty grains ; powdered 
opium, five grains; powdered liquorice, sixty grains. — Mix. 
Make twenty powders. At least three or more daily, beginning 
in the afternoon and^continuing on one or two hours apart until 
profound sleep is induced. Three times per week two small 
fly blisters, size of an ordinary visiting card, should be applied 
below nape of neck, top of each shoulder blade, for six hours 
at a time; or the irritating plaster or tartarized antimony in 
basiiicon ointment. The idea being, as our people are affected 
with tubercular to the extent of seventy-five per cent., and 
syphilis to the degree of fifty per cent, of our entire population, 
to attract or draw those two germs from feeding on the brain. 
There can be little doubt but that tubercular and syphilis are 
at the source of at least seventy-five per cent, of all cases of 
chronic inflammation of the brain and insanity. An invaluable 
remedy here is the bromine, as already laid down. But the best 
plan is, to keep the patient upon a general alterative course with 
bitter tonics until all vestige of inflammation ceases, such as 
compound syrup phytolacca ozonized, or saxifraga glycerite 
of ozone, and when pain has ceased and natural repose is 
obtained, then such remedies as ozone-water, preparations of 
cinchona, compound hypophosphites of lime ; soda should be 
given in small doses. 

The diet should consist, as much as possible, of the chemical 
elements of the brain, as oatmeal, boiled fish, rare beef-steak, 
etc. Change of air of utility. Other remedies sometimes used 
ivith advantage. 

After the pain in the head is relieved, and the patient sleeping 
for ten or twelve hours every night, appetite returning, then 
the glycerite of ozone or kephaline should be administered per- 
sistently. Those two preparations promptly relieve the promi- 
nent symptoms, as the dizziness, mental depression, loss of 
memory and impaired intellectual faculties. They invigorate 

25 



194 DISEASES OF THE NERVOUS SYSTEM. 

rapidly and remove that feeling of nerve tire or exhaustion 
which is so distressing. 

Induration of the Brain. — Effusion of lymph — one of the 
effects of chronic inflammation. The indurated portion of 
small extent presents the appearance of wax or white of egg 
boiled hard. 

The symptoms are often obscure, but it causes loss of memory, 
confusion of thought, derangement of mental powers, loss of 
appetite, desires, affections, passions and paralysis. 

Abscess of the Brain — May be the result of the induration 
or some injury or disease of the ear and temporal bone. It may 
be acute, and severe cerebri tis may be present, pain in the head, 
vomiting, fever, delirium and coma; or chronic, with insidious 
headache, dullness of intellect, sometimes hemiplegia, which 
comes on gradually; it may end in convulsions and death, 
abscess bursting into ventricles of brain. 

The treatment is general alteratives and iodide of potassa. 

Softening of the Brain, Red and White Ramollissement ; 
the word ramollir meaning to make soft. During acute inflam- 
mation an extravasation of blood taking place in or on the 
brain is called red ramollissement, and if it amounts to three 
or four ounces is usually fatal. From obstruction, calcareous 
disease of vessels, embolism and other causes, it may take place, 
and be absorbed, or the portion of brain in which it took place 
may be reduced to the consistency of cream. 

The most common form is the anaemic or white, that caused 
by imperfect nutrition or blood supply, due either to wearing 
out of the brain by overwork or excess, or arterial or other 
forms of degeneration. There may or may not be pain in the 
head ; likely to be sudden and occasional attacks of vertigo ; 
diminution of intellectual power, slow and hesitating speech, 
embarrassment in answering questions, depression of spirits, 
tendency to shed tears on any excitement. Pricking and twitch- 
ing in limbs, perhaps pain or numbness; tendency to sleep, 
especially after meals ; more or less impairment of senses, mental 
faculties impaired, appetite often good, even greedy; limbs 
become the seat of painful cramps, stiffness or contractions; 
paralysis with spasm not uncommon, general sensibility more 
acute. In a large percentage of cases paralysis of one-half the 
body coming on suddenly without the loss of consciousness. 
Patient easily confused, has great difficulty in answering ques- 
tions or in making himself understood. Great feebleness, weak 
and intermitting pulse, vomiting and constipation, difficulty in 
emptying the bladder, often retention of urine with uriniferous 
odor, involuntary escape of stools; respiration labored, at last 
becomes stertorous, coma, ending in death. 

The portions of the brain affected are often of the consistence 



DISEASES OF THE NERVOUS SYSTEM. 105 

of cream. In all cases white softening is the opposite of that 
due to congestion. It is due to a want of nourishment or an 
insufficient amount of blood in the brain. 

Softening of the Cerebellum is attended with fixed pain 
at the back of the head, impairment of sight, hemiplegia or 
paraplegia, tottering gait, vertigo, convulsive agitation, dullness 
of hearing, aphonia, eccentricities of conduct. 

Tumors, Tubercular Deposits, syphilitic growths, hydatids, 
tape worm; cysticera are often found in the brain, and their 
existence is very obscure; headache, sickness, giddiness, mental 
depression, confusion, partial paralysis, epileptic convulsions. 

As to the location of softening, it is thought that the corpus 
collosum. septum lucidum, formix and cerebral substance around 
the ventricles are more frequently affected with red softening; 
whereas, white softening attacks the gray matter of the convo- 
lutions at base, optic thalami, corpora striata. 

Treatment. — It is useless to disguise the fact that we have 
little to hope for in any kind of treatment; still, some cases are 
greatly ameliorated or their progress is arrested by judicious 
use of means. 

•The treatment is very similiar to chronic inflammation of 
the brain: daily bathing, flannel clothing, abundance of sleep, 
feet and extremities kept warm, blisters or plasters to nape of 
neck, bowels and kidneys cared for, diet pre-eminently of phos- 
phates, oatmeal, boiled fish, wheaten grits, otherwise generous. 
Alteratives and tonics. There are two remedies of undoubted 
utility — iodide of potassa and ozone-water. We must never 
shut our eyes to the fact, that by far the greater number of cases 
are due to affections of the blood; hence, the very remarkable 
success of those two preparations. Indeed, so convinced am I 
of the fact of their great efficacy in softening, that I could fill 
this volume with cases that have made wonderful improvement ; 
memory, good judgment and the senses being washed, as it were, 
free from germs of tuberculse, syphilis, etc. The alterative saxi- 
fraga is the best as the case progresses ; glycerite of ozone and 
kephaline alternately will effect a good cure. 

HYDROCEPHALUS. 

Dropsy of the brain is often congenital and associated with 
cerebral malformation; when not dependent on that, it is more 
commonly the result of tubercular meningitis. It is rarely met 
with after two years of age. 

The head in hydrocephalus usually attains a great size ; the 
unossified sutures yield readily to the pressure of the fluid. 
One side may be larger than the other; bones thin and trans- 
parent ; meninges thickened. Serum usually contained in lateral 
ventricles, which are expanded into one large cavity; occasionally 



196 DISEASES OF THE NERVOUS SYSTEM. 

collected in sac of arachnoid, compressing brain. Quantity 
of fluid varies from a few ounces to a number of pints. 

The predisposing cause is tuberculse. The exciting causes 
are numerous, such as would be likely to bring about inflam- 
mation, falls, blows, reflected irritation, as teething, worms, 
cholera infantum, etc. 

Symptoms. — General symptoms of tubercular meningitis to 
a greater or less degree, followed by extreme wasting of the 
body. Although the child may eat ravenously there is no nutri- 
tion. The appearance is remarkable; skin very white, body 
emaciated, face small, with a large globular cranium and over- 
hanging forehead ; head drops helplessly on one side. There 
may still exist a little inflammation; if so, there will be head- 
ache, irritability, restlessness, sleeplessness and a susceptibility 
to noise, light, motion. Intelligence very feeble; great pros- 
tration and muscular weakness; rolling movement of head, 
eyeballs, perhaps squinting and blindness; great liability to 
epileptic convulsions; nausea, constipation, with dark-colored, 
offensive stools; grinding of teeth, screams on awaking. As 
the case progresses there is more pallor of the surface, a great 
deal of stupor, very slow pulse, dilatation or contraction of 
pupils, picking of nose and lips. In favorable cases the head- 
ache and irritability subside ; the skin assumes a better color, 
there is more energy, appetite becomes more natural and the 
body nourishes. If there is great prostration, rapid pulse, 
paralysis, coma or convulsions, it is very apt to end in death. 

Treatment. — Infants of a tubercular diathesis, with a ten- 
dency to any irritation of the brain, should be well cared for, 
and their constitution strengthened by every possible means. 
Nourishing food, abundance of good milk, beef juice, country 
air; seaside in summer; daily bathing, followed by inunction 
of oil, and when they become older, great precaution should 
be used, especially against any mental strain. 

To get rid of the effusion, be sure its cause is removed; that 
is, all irritation. Then the principles of treatment are precisely 
the same as effusion of serum or dropsy. Small doses of infusion 
of digitalis, infusions of parsley or asparagus with nitrate of 
potassa. Open bowels free! T with : 

Mandrake, pulverized, two grains; nitrate of potassa, five 
grains; cream of tartar, thirty grains. — Mix. Make one pow- 
der. Give one as often as the bowels will bear it. In addition, 
give two grains of iodide of potassa three times a da}' in infu- 
sion of squills. An infusion of hair-cap moss is also of great 
utility. 

Diaphoretics, as warm alkaline baths. Compression of head 
a very doubtful proceeding; if attempted, let it be gentle and 
equable on all parts. Puncture, if resorted to, must be done 



DISEASES OF THE NERVOUS SYSTEM. 197 

at coronal suture, about an inch and a half from anterior fonta- 
nels, so as to avoid longitudinal sinus.. The fluid to be slowly 
evacuated either by aspirator or small trocar and canula; gen- 
tle pressure must be made during and subsequent to its escape. 
Not to be resorted to until all other means fail. 

HYDROCEPHALOID DISEASE. 

A tubercular form of disease of the brain of children under 
two years of age, who suffer from the depressing effects of solar 
heat, city life and bad food. It has some resemblance to tuber- 
cular meningitis. It is very frequently associated with or is a 
result of teething and cholera infantum. 

There is great prostration, heaviness of head, drowsiness, 
languor, chop-spinach stools, wakes from sleep in alarm, screams, 
dread of strangers, freaks of temper, irregular breathing, no 
fever, skin white and cool; surface of fontanelles depressed 
instead of raised, as in hydrocephalus. 

The main point in treatment is to destroy the tubercular 
germ and overcome the diathesis. Alteratives, as saxifraga, 
iodide of potassa, tincture of iodine in milk, removal of all 
sources of irritation, correcting the secretions, bathing, pure 
milk, strong beef tea or finely pounded meat, raw meat, coun- 
try or seaside air. General treatment for tubercular, glycerine 
of ozone and keph aline. 

APHASIA. 

Loss of the cerebral faculty of speech and of the power of 
expressing thoughts by writing or gesture. A simultaneous 
loss, in a greater or less degree, of the memory of words or acts, 
by means of which words are articulated, and also of intelligence. 

That transitory form so common in the recovery from fevers, 
typhoid anddiphtheria,dueto congestion or ana3mia,from which 
recovery always takes place, is not what we desire to notice ; it 
is the form that is permanent and due to softening of the brain 
from embolism or thrombosis, haemorrhage or poison of syphilis, 
or due to the absorption of lead, nitrate of silver in hair dyes, 
or the inunction of bismuth and arsenic in face powders, or to 
the terrible effects of nicotine in tobacco. These agents in their 
use cause irritation and softening of the posterior portion of 
the third frontal convolution of the brain on the left side. 

Symptoms. — It may come on either slowly or suddenly, and 
may or may not be associated with germinal softening. It is 
ushered in by loss of the power of speech, which may be regained 
and recur again and again. In some cases words are recovered 
and employed and ultimately lost. Again, speech may make 
a temporary return under excitement, and then leave. Move- 
ment of lips, tongue and larynx may be healthy. There may 



198 DISEASES OF THE NERVOUS SYSTEM. 

be consciousness of what is wished to be expressed, and yet 
complete inability to express the thoughts by speech, writing 
or even gesture. The patient may know the use of an object, 
but cannot name it. They may read, but if they understand 
what they peruse they forget directly, as they will pore over 
and over again the same page. There is the greatest possible 
diversity in the impairment of the mental powers, usually hemi- 
plegia and a complete breaking down, with the worst form of 
cerebral disease. 

In cases clearly due to the use of hair dyes, face powders, 
tobacco, syphilis, gout, if not of too long standing, there may 
be hope from the general treatment of chronic inflammation 
of the brain; especially, plasters and blisters to nape of neck, 
with alteratives and tonics. Iodide potassa in alternate use 
with ozone-water. These two remedies are of infinite value in 
clearing the brain of such deleterious compounds. No remedy 
of any avail in aphasia and white softening, due to the use of 
the auriferous or golden hair dyes, such as the peroxide of 
hydrogen. In aphasia of six months' standing, with hemiplegia, 
medicine seems powerless to effect a cure. 

APOPLEXY. 

An exhaustion of the cerebral pulp, with anaemia or conges- 
tion, and the devitalization so great as to cause the patient to 
fall down, as if from a blow. 

Causes. — Anything that tends to exhaust the vital integrity 
of the brain, whether that cause may be predisposed to by 
hereditary tendency, peculiar types of conformation, aggravated 
or intensified by sedentary habits, high living, protuberant 
bellies, large heads, florid features, short, thick necks, high 
shoulders, a predisposition to hemorrhage. Apoplexy is also 
engendered by disease of the liver, heart, kidneys, ossification 
and calcareous degeneration, and deposits of cerebral blood- 
vessels, gout, intemperance, embolism, impure air, tight neck- 
ties, stooping posture. 

Varieties. — Nervous or simple apoplexy, fatal with a trace, is 
rare; the sanguineous, or that accompanied with extravasation 
of blood into the brain, very common; and the third form, the 
serous, in which the serum effused is simply present and has 
no relation to an attack. A stroke or an attack is usually fol- 
lowed by stupor or coma, and the comatose condition may cease 
in various ways. It may gradually pass off, leaving the patient 
well ; or it may terminate in incomplete recovery, mind impaired 
and some part of the body paralyzed; or it may terminate in 
death. In the latter case, on examining the brain, we find either 
no appearance of disease or else extra vasated blood is discovered 
in the ventricles, or pons varolii, or to a certain amount in the 



DISEASES OF THE NERVOUS SYSTEM. 199 

centrum ovale majus, or in sac of arachnoid, or there may be a 
copious effusion of serum into ventricles or beneath arachnoid, 
with or without cerebral softening. That form which is fatal 
without any trace is very rare. That in parturient women is 
generally a clot embolism from ergot. 

Warnings. — Frequently there are no premonitory indica- 
tions or threatenings; when there is, they are characterized by 
headache, vertigo, muscaB volitantes, or transient blindness, or 
double vision, ringing in the ears, a feeling of weight and full- 
ness in the head, often bleeding from nose, fits of nausea, occa- 
sional sense of numbness in limbs, loss of memory, great mental 
depression, incoherent talking, drowsiness, indistinct articula- 
tion, and partial paralysis of foot, limb, face, eyelids. 

An attack usually begins in one or other of three forms : 

1. Patient falls suddenly down, deprived of sense and motion, 
like a person in a sleep ; flushed or even livid ; breathing ster- 
torous, pulse full but slow, much below the natural standard; 
often convulsions, or rigidity, or contraction of the muscles of 
the limbs on one side. 

2. Sudden, and it may be excruciating pain in the head, pallor, 
sickness, faintness, often vomiting; frequently the patient falls 
to the ground in a state of syncope, coma. In other cases, 
instead of falling, the pain in the head is accompanied by a 
slight and transient loss of consciousness, then headache, with 
heavy oppressed feeling in the head, which terminates in forget- 
fulness and coma, from which recovery is rare. Clot of great 
size is generally found in the brain. 

3. Or it may come on with all the symptoms of cerebral 
haemorrhage, paralysis of one side, loss of speech, but no loss 
of consciousness. The paralysis leads to coma, or it may pass 
off and the patient recover ; or it may pass off and death sud- 
denly occur in a few hours or days, or it may terminate in another 
attack. 

Apoplexy has well marked and general characteristics : its 
duration varies in all cases from a few hours to as many days. 
Complete and total unconsciousness; pulse generally at first 
imperceptible or small, but as the patient rallies, stronger and 
fuller as the shock wears off, but slower than natural and often 
intermittent; respiration is slow and embarrassed or stertorous; 
frothy saliva flows from the mouth, and in bad cases the body 
is covered with a cold, clammy sweat; face is either congested, 
swollen, livid or very pale; eyes dull, glassy, pupils insensible 
to light, often one contracted or the other widely dilated ; ptosis, 
or dropping of eyelids or squinting, according to the nature of 
the effusion and its location; teeth firmly clenched, power of 
deglutition lost or impeded, bowels constipated, motions passed 
involuntary, involuntary micturition. When it is of the san- 



200 DISEASES OF THE NERVOUS SYSTEM. 

guineous type, it is not unusual for neck and even shoulders to 
show congestion and lividity. Incomplete recovery is almost 
always followed by paralysis. 

Treatment. — If the condition in any of its three forms is 
suspected, the patient should be warned to guard against all 
bodily exertion, as running, jumping, lifting, hoisting, or violent 
mental emotion or passion, or straining at stool ; and tea, coffee, 
tobacco, whisky, beer and venereal excitement strictly for- 
bidden ; heavy meals or much animal food, stooping, tight neck- 
ties, hot baths, and even extremes of temperature to be avoided. 
Diet to be nutritious but light, bed-room cool, well ventilated, 
to sleep on a hair or straw mattress with head high ; hair kept 
short, shower or cold-water bathing, daily moderate exercise, 
bowels to be open twice daily. Two points of irritation between 
shoulders kept discharging, at least one inch square; a little 
capsicum in socks. If there is vertigo, bleeding at nose and 
headache, bowels more active, bromide of potassa, tinctures of 
aconite and belladonna administered. If not speedily relieved, 
wet cups to nape of neck and shoulders. If anaemia is predomi- 
nant, cinchona, mineral acids, with nutritious, easily digested 
food. 

Suppose an attack to have taken place and that it is of the 
sanguineous type, with coma, labored breathing, pulse slow, 
imperceptible almost, the face turgid with blood, almost purple 
or black, neck ecchymosed, etc. Then our treatment would be 
precisely the same as for acute inflammation of the brain : shave 
the head and apply hot water, wet cup nape of neck and shoul- 
ders ; mustard roller to feet and limbs, free purgation with com- 
pound powder of jalap and senna, with a few drops of croton 
oil, and repeat it; head high, and if stertorous breathing continue 
to be placed on right side ; then veratrum viride with bromide 
of potassa; otherwise, general principles. 

Suppose it is an attack with anaemic syncope : no pulse, sigh- 
ing respiration, cold, clammy skin, pale face, etc.; we must 
stimulate, warm water to head, no cups nor free purgation, but 
stimulants. An effort must be made to rouse the patient with 
stimulating enemas, nutritious diet, and a course of treatment 
similiar to chronic inflammation of brain. 

CONCUSSION OF THE BRAIN. 

A shock or concussion of the brain is usually caused by ajar, 
blow, fall, or some mechanical injury; and it may also be the 
result of some depressing passion. 

In our present abnormal civilized condition, shocks or concus- 
sions are much more common than is generally supposed. By 
our improved means of traveling by railroads, jars and shocks 
are very detrimental to the brain. The strain and struggle for 



DISEASES OF THE NERVOUS SYSTEM. 201 

existence, the exciting emotions, perverted desires, depressing 
passions, blighted affections. Certain drags or poisons have a 
highly depressing or jarring effect, as alcohol ; large doses of 
quinine, phosphorus, opium, etc., have a direct depressing effect 
on the cerebrum. 

In the treatment of brain shock, absolute or perfect rest, so 
that the vital forces of that delicate organ may react. Rest in 
recumbent posture in bed. If there is headache, bowels opened, 
stimulants to feet and stimulating applications to head. Aconite, 
belladonna, valerian, sumbul or bromide of ammonia should 
be given in small doses, and pretty moderate doses of hyosciamus 
to procure an excess of sleep. 

If brain shocks or jars or concussions were more promptly 
attended to, there would be fewer cases of cerebral disease. In 
our present mode of dietetics, our brains are literally starved 
for the want of a diet of phosphates. Our people should eat 
more boiled fish, oatmeal and whole corn bread to give this 
organ better nourishment. 

HYPERTROPHY AND ATROPHY OF BRAIN. 

Hypertrophy of Brain may occur in children, although it 
is more common between twenty and thirty years of age. The 
increase in volume is generally due to connective tissue. It may 
increase in size, and few symptoms manifest themselves until 
an attack of convulsions, which terminates in death. When 
the bony case does not enlarge, there are necessarily indications 
of compression, mental disturbance, varying from slight dull- 
ness of intellect to complete idiocy. Headache, vertigo, loss 
of muscular power or paralysis, unaltered or very slow pulse, 
severe epileptic convulsions. Death from coma. 

Atrophy of Brain is becoming very common among boys. 
The strong-minded mother reacts upon the boy in imparting 
to him a simple incomplete development of certain convolutions 
above ventricles. So boys with that class of mothers are remark- 
able for small heads and effeminacy. Isolation or monotony 
contracts the convolutions. Tobacco whittles down the brain 
immensely; so does syphilis and other poisons. 

Haemorrhage in the Brain bears no analogy to apoplexy, 
only some of its symptoms may be present. It may come on 
in various ways, with congestion, from straining, stooping or 
from passion, and be accompanied by symptoms of apoplexy 
and paralysis of one side; or it may come on during sleep, 
patient waking up paralyzed ; or it may come on suddenly, the 
affected individual falling or staggering, feeling faint, giddy, 
confused, but not unconscious. May vomit or become coma- 
tose, or turn suddenly hemiplegic; the comatose form most fatal. 
The principle feature in all cases is the paralysis of the opposite 



202 DISEASES OF THE NERVOUS SYSTEM. 

side of tlie body from the clot. Sensation may or may not be 
affected. 

Haemorrhage may take place into any part of the brain 
and gives rise to an immense variety of symptoms. It is not 
necessarily fatal unless it takes place in the bulb or medulla 
oblongata. 

Treatment. — Same as apoplexy, followed by a long alterative 
course, with two open sores at nape of neck. 

DELIRIUM TREMENS, OR CHRONIC ALCOHOLISM. 

Alcohol in any form, taken into the stomach, causes irritation 
of that organ, sometimes inflammation ; it is then taken up in 
the blood and in that fluid circulates as a free agent ; and in its 
passage through the various organs of the body it irritates and 
retards their working capacity, or arrests change or metamor- 
phosis, and ultimately it finds its way to the brain, for which 
organ it has a special affinity, and where it imbeds itself and 
also irritates. It may excite the cerebral functions, but even 
that is followed by a double state of depression. The repeated 
imbibing of alcoholic compounds induces chronic inflammation 
of the brain, with effusion of lymph, which causes thickening 
or induration of its entire substance; besides, the brain being, 
as it were, steeped in whisky, undergoes a shrinkage and takes 
on atrophy. This shrinkage or whittling down of the brain, 
in addition to the state of chronic inflammation, gives us a 
peculiar condition of that organ, viz: atrophy, induration, with 
true anatmia of the brain. 

This is the condition present in all cases of delirium tremens; 
besides, there is no organ in the entire body free from the 
destructive effects of the deadly poison. 

In chronic alcoholism it is scarcely possible to realize the 
true degradation and disease produced: the brain suffering 
atrophy and anaemia, from the facial angle of longevity down to 
a cipher, fatty degeneration of heart, liver, kidneys; fat, a non- 
vital element, usurping the place of vital tissue. The fountains 
of life are deteriorated, and the drunkard's spermatozoa, if capa- 
ble of vitalizing the female ovum, can only beget an idiot, or 
one of feeble mind or afflicted with tubercular brain disease. 
Besides thus dwarfing his offspring, his moral and intellectual 
faculties are blunted. 

Alcohol causes a want of equilibrium between the gray and 
white matter of the nervous system; as a result, there is tremor 
all over, the tongue is very tremulous, large, flabby, white-coated, 
very moist, and when told to put it out is unable to do so, but 
thrusts it out; the breath is acidulous, and possesses a chloro- 
form odor from the imperfect combustion of saccharine elements 
in the lungs ; the skin is white, soft, doughy and acid-smelling ; 



DISEASES OF THE NERVOUS SYSTEM. 203 

the nose and cheeks may be red, as they are so abundantly sup- 
plied with sebaceous follicles, which are over-worked and in a 
state of inflammation, having to do the work of the liver. 

The impetus of the poison falls upon the brain, irritating and 
poisoning that organ. The drunkard's headache is one aggra- 
vated by noise, light, heat, motion; vertigo is intense, so is the 
tinnitus aurium and muscse volitantes. The latter is very great. 
The minute filaments of the optic nerve are so depressed that 
they have lost their contractile power over the vessels of the 
aqueous humor and choroid; that the vessels supplying those 
structures have become varicose, and when the brain looks at 
the external world through the optical instrument — the eye — 
it sees the varicose vessels which it compares to objects in the 
external world; hence, the drunkard's sights are no hallucina- 
tion, but a true pathological condition. Head often cool and 
moist; pupils at first contracted, latterly dilated; conjunctiva 
pale ; mental derangement ; expression of countenance wild ; eyes 
fixed intently on some imaginary object; constant efforts to 
avoid them; motions sudden and rapid; tremor of the hands, 
limbs and tongue ; pulse nearly natural ; constant desire to move 
about; inability to concentrate his thoughts for any length of 
time; perfect inability to sleep; mind wandering and delirious ; 
general appearance of debility; incessant irritability, restlessness 
and sleeplessness: appetite absent; constipation; delirium aggra- 
vated toward night; incessant talking; constant tremor and 
twitching of the muscles ; great prostration, with an aggravation 
of all the symptoms, ultimately terminating in death. 

As the pathology of this affection is well understood to be 
anaemia, atrophy and induration of the brain, the indications 
for treatment are very plain. The excitement, irritability and 
sleeplessness which are gradually wearing out the patient, must 
be relieved. The secretions are either arrested or perverted, 
and there is a poison undermining the powers of life. 

If the patient is docile and obedient, it is an excellent plan 
to begin with an emetic of the compound powder of lobelia, with 
free drinking of bicarbonate of soda-water. Get the action of 
full, free emesis, if possible ; follow this with a warm bath and 
an active purge of compound powder of jalap and one or two 
drops of croton oil. Then procure sleep either with fifteen-grain 
doses of chloral hydrate and bromide of potass, or hypodermic 
injection of a quarter or half grain of sulphate of morphia. 
After ten or twelve hours of sound, refreshing sleep, then place 
him upon a stimulant, such as thirty grains of capsicum every 
four hours in warmed milk, in alternation with half-teaspoonful 
doses of tincture of oTeen root p-elseminum. Abundance of 
fluid nourishment, beef tea, milk. Our remedies here are very 
limited, but they meet the points in the case with great precision. 



204 DISEASES OF THE NERVOUS SYSTEM. 

Chloral and hypodermic injections, even when the patient is 
a raving maniac, seldom fail to effectually control him, and the 
subsequent action of the capsicum and gelseminum are unsur- 
passed. The patient should be kept quiet, all sources of mental 
irritation be removed, and otherwise well cared for. 

In milder cases, remedies of less power may be used, as hyos- 
ciamus, to procure sleep ; cimicifuga,where there is great nervous 
excitement and spasm ; liquor ammonia acetatis may be tried ; 
indian hemp operates well ; digitalis, in some cases, might be 
substituted for the gelseminum. No whisky nor any alcoholic 
stimulant allowed, unless small doses of tartarized antimony 
are mixed with it, which speedily arrests the craving. 

COUP DE SOLEIL, OR SUN STROKE. 

A devitalized condition of the brain, caused by solar heat 
and evaporation of the serum of the blood. 

It gives rise to faintness, a craving for water, heat and dryness 
of the skin, high temperature or coldness, great nervous depres- 
sion, vertigo, tightness across the chest ; pulse variable, often 
quick and full, at other times thin and feeble, so that it can 
scarcely be felt. As the case progresses heart's action becomes 
violent; stupor, so that the patient cannot be roused; face 
becomes pallid ; vomiting, coma, great difficulty of breathing, 
contracted pupils. While in this state the conjunctiva may 
become congested, action of heart intermittent, and just prior 
to death dilatation of pupils, gasping respiration, and it may 
be vomiting. 

In some cases symptoms are very insidious : mere listlessness 
and stupidity, with languor and debility, head feeling strange, 
yet in a few hours death. In other cases often exposure to the 
sun ; the individual has suddenly fallen down insensible, made 
one or two gasps, and died in a state of syncope ; the brain being 
enervated, the blood deficient of its serum (clotty,) and the secre- 
tions deranged. If recovery does take place, convalescence is 
apt to be retarded by a slight fever, some complications of heart, 
lungs, liver, kidneys, or from paralysis or prostration. Patient 
not free from danger for some time. A great while after apparent 
recovery symptoms of paralysis and insanity may be developed. 
In every case, just like recovery from inflammation of the brain, 
the patient is easily affected, and never the individual he was 
before the attack. 

Treatment. — If one lias to be exposed during the hot season 
to the sun's rays, quinine is our best drug as a prophylactic; 
besides, proper care of the dress and an abundance of water 
not iced. On no account must alcohol be used, as there may 
be utility in coffee or malto cocoa. 

The greatest good is to be derived from the judicious use of 



DISEASES OF THE NERVOUS SYSTEM. 205 

tepid or even moderately warm water, wrapping the patient in 
a nude condition up in sheets or blankets saturated with or 
wrung out of warm water, keeping them moist by pouring it 
freely over them, so that the skin may imbibe the water, an 
element essentially needed in the blood, besides the revulsive 
effects of the water on the periphery of the nerves on the skin. 
The head, also, should be encased in packs, and even copious 
enemas of tepid water. If the tongue is coated, an emetic of 
mustard and salt, allowing the patient to drink freely of tepid 
water and bicarbonate of soda. After it has acted gently, follow 
with half a teaspoonful of compound liquorice powder, in which 
one drop of croton oil has been rubbed up, and repeat if bowels 
are not promptly opened. Allow the patient as much water as 
he may desire to drink, for water is the remedy. 

As soon as the patient can swallow, half teaspoonful doses of 
the sesqui-carbonate, freely diluted with water, is a good remedy 
to liquify the blood, given as often as indicated by the condition 
of the heart. If the patient does not react, no improvement, 
then cup the nape of neck, shoulders, and apply mustard plas- 
ters to feet and hands, still holding on to the water, and an 
alkali internally. If a stimulant is necessary, carbonate of 
ammonia, liquor ammonia acetatis and artificial heat; other- 
wise, the case should be managed like chronic inflammation of 
the brain. 

EPILEPSY. 

A weakness or irritation of a patch of the brain, with an 
impaired cerebro -spinal centre Avhich leads on the slightest dis- 
turbance to an explosion between the positive and negative 
forces of that organ, which produces the characteristics of sud- 
den loss of consciousness and sensibility, power of voluntary 
motion, with tonic convulsions lasting a few seconds, and fol- 
lowed by clonic spasm of voluntary muscles; cessation succeeded 
by exhaustion and coma. Attacks recurring at intervals. With- 
out a weakened bulb and neighborhood epilepsy could not exist. 

The causes may be embraced under three general heads : — 
(1.) Centric causes. (2.) Reflex. (3.) Blood diseases. 

(1.) Hereditary conformation, consanguinity, peculiar shape 
of skull, depression or excrescence from its walls, tumor, worms ; 
weakened patches by falls and blows in infantile life. 

(2.) Reflex, caries and overcrowding of teeth, vaulting of the 
roof of mouth, giving rise to irritation of the trigeminus, the 
most reflex nerve in the entire body. Irritation anywhere, espe- 
cially in the abdomen, for of all the regions of the body none 
reflect more strongly on the brain than the visceral organs ; so 
we must look well to the stomach and bowels for worms ; if 
there is great mental depression, melancholia, for a loaded or 



206 DISEASES OF THE NERVOUS SYSTEM. 

sacculated colon, the kidneys, bladder and irritation of the 
generative organs in both seves, etc., etc. 

(3.) The blood, the living germs of tubercle, cancer, syphilis, 
rabies, and even the ovum of parasites will nestle and form 
colonies in patches of the brain weakened by falls and blows, 
and thus increase the condition of molecular death. 

Epilepsy is characterized by general languor, debility, lassi- 
tude ; patient soon acquires a nervous temperament, sharp fea- 
tures, white skin, with an excess of brain-waste in urine in the 
shape of phosphates and chlorides. If the fits are about to 
appear, there are in about two-thirds of all cases what is termed 
a warning or premonitory symptom, which consists usually of 
some nervous sensation, different in duration and character, 
such as spectral illusion, hallucination of smell, taste, headache, 
giddiness, vertigo, twitching, confusion of thought, sense of 
fear, etc., etc. But the aura epileptica occurs in the large pro- 
portion of cases ; some compare this to a current of hot or cold 
air passing by; others to a stream of cold water running on 
the skin, a fullness in head, a sense of burning or tingling or 
a pricking sensation, drawing inwards of the thumbs, a feeling 
as if insects were creeping, the sensation beginning in some 
remote part and extending to the head. Usually when aura 
ceases fit commences. 

The real symptoms : white or cadaverous appearance or pallor 
of features, with utterance of a shriek or scream; and that may 
not take place, but the patient falls to the ground insensible, 
with loss of voluntary motion and violently convulsed; con- 
vulsive movements continue violent, usually more marked on 
one side than the other ; distortion of face, gnashing of teeth, 
foaming at the mouth ; protrusion of the tongue, which is often 
bitten ; eyes partly open and suffused ; eyeballs rolling and insen- 
sible to light ; skin cold and clammy ; perhaps involuntary mictu- 
rition and defecation; vomiting; breathing laborious, seems 
about to be suspended ; when the limbs are stretched out a deep 
sigh is drawn and the fit passes off. Patient left insensible and 
as in a sound sleep, with stertorous breathing, from which he 
recovers with a feeling of stupor and exhaustion and headache, 
but without any knowledge of what he has gone through. Some 
hours subsequently small ecchymosis often detected on face, 
neck and chest. 

The fit may be very light or very severe; its duration may 
be a few minutes or extend to many hours. Fits, when slight, 
often only consist of giddiness, confusion of mind, loss of con- 
sciousness, little or no convulsion and stupor, and all over in 
less than a minute. Seizures occur at variable intervals ; often 
occur at night without being suspected by patient or friends. 
Repetition of attack impairs memory, may cause cerebral haemor- 



DISEASES OF THE NERVOUS SYSTEM. 207 

rhage, temporary or permanent paralysis, or dementia, idiocy. 

The most hopeless cases are those due to centric causes in the 
brain or skull, defective nervous organizations, lesions of the 
meninges. That due to irritation, reflected or propagated, or to 
a morbid state of the blood, if not of very old standing, are 
amenable to treatment. 

The great increase of epilepsy is due to the vices or defects 
of civilization, the brain being more susceptible to irritation, 
abnormal conditions of alimentary canal, uterine irritation, 
masturbation, venereal excesses, alcoholism, tobacco, syphilis, 
mercury, etc., etc. 

Treatment. — The symptoms are those of a sudden explosion 
of accumulated nervous energy. From the periodical character 
of the fits, it is inferred that the accumulation of nervous energy 
goes on for a definite time in the brain and spinal cord until 
an explosion ensues, which spends itself upon the muscles of 
voluntary motion, which are thrown into violent action, and by 
these means the accumulation is exhausted — the explosion being 
followed by coma or deep sleep. 

Many measures have been proposed for preventing the gradual 
accumulation and sudden explosion of the nervous energy con- 
stituting epilepsy, as improving nutrition, restoring mental and 
bodily vigor by any possible means, abundance of exercise in 
open air, daily bathing. 

Treatment during a fit should be directed chiefly to protecting 
the patient from violence, and getting him out of the fit. All 
clothing should be loosened, so that the blood may have free 
circulation to and from the head and all parts of the body. A 
piece of pine wood should be placed within the teeth to save 
the lips and tongue from being wounded by the spasmodic move- 
ments of the jaws. The patient should be placed on right side 
on bed or floor, head well elevated, and restrained or guarded, 
so that no personal injury is inflicted. Cloths wrung out of 
warm water should be applied to the head ; mustard to the feet. 
Enemas of some broth, or mucilaginous tea, with half a tea. 
spoonful of spirits of turpentine, operate very favorably. Tying 
a ligature around the limb in which the aura is experienced 
prior to the fit, to ward it off, of doubtful utility. 

If fit lasts long, a hypodermic injection of one-quarter of a grain 
of sulphate of morphia in the cellular tissue of nape of neck 
or over deltoid instantly rouses the patient up. Snuff, inhaling 
nitrite of amyl, etc., rather to be avoided. 

During the interval, while the fit is off, there must be a vigorous 
effort to prevent a recurrence or suspend the explosive tendency 
of the positive and negative forces of the brain with sufficient 
doses of bromide of potassa and other remedies to diminish 
or allay the reflex excitability and force of the cerebro-spinal 



208 DISEASES OF THE NERVOUS SYSTEM. 

centres. Such a formula as one of the following is efficient : 

Fluid extract of sumbul, four ounces ; tincture of calabar 
bean, one ounce ; bromide of potassa, one ounce ; bromide of 
ammonia, two drachms ; bicarbonate potassa, two drachms ; 
tincture of belladonna, thirty drops. — Mix. One teaspoonful 
or more — sufficient to ward off the fits ; or the following is cheaper: 

Camphor water, four ounces ; bromide of potassa, one ounce ; 
iodide of potassa, two drachms; carbonate of ammonia, half 
an ounce. — Mix. Dose, from one to more teaspoonfuls, sufficiently 
often to ward off attacks. 

Bromide of potassa is a salt of high diffusive power, readily 
entering and quickly leaving the blood. It should be given 
freely diluted with water on an empty stomach; otherwise, part 
of it escapes from the system without being absorbed. Besides, 
its well known power in producing anaesthesia of the medulla 
oblongata, thus diminishing central irritation. It has a simi- 
lar effect on the motor and sensory nerves. Bromide of lithium 
is a more powerful salt than the potassium, containing more bro- 
mine, but is not efficient in epilepsy. The dose of the bromide 
of potassa should be from forty to sixt}^ grains per day ; not 
one grain more should be given than the quantity required. 
The addition of the bicarbonate of potassa in the one prescrip- 
tion and carbonate of ammonia in the other, increases the action 
of the bromine materially; besides, they are anti-acid and 
protect the stomach against brominism. The rule is, bromine 
enough to act successfully on the bulb, but not to produce a catar- 
rhal condition of mucous membrane with a train of miserable 
s} 7 mptoms in which the remedy must be stopped. Bromide 
operates best on the heavy fits ; it has less effect on the light. 

If it is a boy or young man with short hair, an ointment of 
equal parts of chloral hydrate and camphor dissolved in vase- 
line, should be rubbed into the entire scalp at bed-time ; in case 
of a lady, well up in nape of neck. It is a valuable help, whether 
it acts by continuity of tissue or by causing some molecular 
alteration in the periphery of the nerves and occasioning the 
same alteration in the nerve trunks, or in their nuclei, or by 
reflex action, it is impossible to say. 

The liver and colon should be roused into action by compound 
liquorice powder and colocynth. There are a large number of 
cases where the central irritation is kept up by eccentric causes 
as a worm, fistula, tight or elongated prepuce, or clitoris, which 
latter being removed, the central irritation is easily combated 
by the application of ice to the sympathetic nerve which issues 
from the last cervical and upper dorsal vertebrae, and by small 
doses of the bromine. The value of ice is effective in propor- 
tion to the youth of the patient and acuteness of the case. It is 
rarely beneficial in the chronic epilepsy of adults. 



DISEASES OF THE NERVOUS SYSTEM. 209 

Young children, from one to six years, sleeping in closed rooms, 
are subject to frequent attacks at night of screaming, with insensi- 
bility and semi-convulsions, due to the protracted inhalation of 
air deficient in oxygen and laden with carbonic acid gas. For 
this the chlorate of potassa is a sovereign remedy, and for the 
true convulsion and epileptic attacks in children it often proves 
curative. It is of no utility in the adult, unless combined with 
bromide. 

While warding off attacks, remove the cause if it is admissible. 

In Infantile Epilepsy , we must look for falls, blows, teething, 
irritation of the stomach and bowels, worms, and remove by 
lancing gums, emetics, cathartics and vermifuge remedies. 

If caused by fright or mental emotion, aconite, belladonna, hyos- 
ciamus, citrate of caffeine, etc. 

If caused by indigestible substances, emetics, compound anti- 
bilious pills, etc. 

If by worms, the active principle of pomegranate root, valdivine. 

If by suppressed menstruation, compound betin pills, warm 
teas, etc. 

If by masturbation, large doses of tincture of green root gel- 
seminum, with circumcision and shortening clitoris. 

If caused by blood disease-germs, as tubercle, syphilis, etc., etc., 
iodine, glycerite of ozone and water, nitric acid in compound 
tincture of cinchona, iodide of potassa, phytolacca, general 
alteratives and tonics, as laid down under each ; and in all cases, 
either repeated blisters or irritating plasters, or the antimonial 
plasters below nape of neck, an open sore, so as to attract the 
germs of disease to another pasture-field, away from the vital 
organ — the brain. 

The use of ozonized remedies in the treatment of epilepsy 
marks an era of great success, and bids fair to bring this hitherto 
stubborn disease within the class of curable affections. Our 
plan of treatment, after holding off the fits, is a removal of 
causes and treatment for that, an alterative and tonic course, 
and a judicious use of ozonized glycerine and water. 

In distinguishing the true epilepsy from the feigned, the fol- 
lowing are good land-marks for a guide. In the feigned, the 
patient does not fall violently but deliberately, to avoid injury ; 
eyes are closed but pupils contract to the stimulus of the light ; 
tongue and lips never bitten ; face red, congested instead of 
being pale; skin healthy; blow snuff into the nostrils and 
patient sneezes. A proposition to apply the actual cautery to 
the spine effects an instant and permanent cure. 

Picrotoxin. — The tincture of cocculus indicus in ten drop 
doses morning and night, and gradually increased until it pro- 
duces cerebral congestion. It keeps the cephalic vessels in a 
state of permanent relaxation, and thus prevents the vascular 

26 



210 DISEASES OF THE NERVOUS SYSTEM. 

spasm which produces the sudden ansemia of the brain, the 
fundamental condition of the initial stage of an epileptic attack. 
It is most useful in long-standing cases in which bromine has 
failed. Remedy to be increased very gradually to a point to 
be effectual. 

CATALEPSY. 

A very remarkable disease of the brain and nervous system, 
characterized by a sudden loss of the senses, intelligence and 
voluntary motion ; the patient retaining the same position during 
the paroxysm as that held at the moment of the attack, or in 
which he or she may be placed during its continuance. Seizure 
may last a few minutes, several hours or even days, without 
regard to regularity of periods. There may be premonitory symp- 
toms, as headache, irritability of temper, yawning, tinnitus, ver- 
tigo, palpitations, impairment of mind, confusion of senses, all 
coming on suddenly ; the eyes are fixed, either open or shut ; 
pupils dilated ; restoration or recovery takes place suddenly, 
accompanied with sighing, pain or confusion in the head, with 
no recollection of what has occurred. No efforts to restore con- 
sciousness are effectual. Nervous and hysterical women are 
most liable to its attacks. 

Catalepsy differs from ecstacy , somnambulism or clairvoyance, 
in its being associated with disease. Absence of mind is, in 
many cases, a mild form of catalepsy. Mesmerism and spirit- 
ualism are also a species. There is usually little danger from the 
attacks, but the tendency is to terminate in apoplexy, insanity 
or white softening. It is often associated with some organic 
affection of the brain, as a tumor, a bony or calcareous growth. 
Anything that tells badly on the nervous system, as grief, worry, 
debility, intense mental application, the nervous exhaustion of 
tubercle, syphilis, mercury, may give a predisposition to it. 

The exciting causes are, violent mental emotion, as fright, 
terror, suppression of menses, uterine and ovarian disease. 

Treatment — Embraces general alteratives and tonics, directed 
to the supposed cause. Irritating plaster to nape of neck, skin 
well stimulated, bowels active, shower baths and a persevering 
use of ozone-water and glycerite of ozone. 

Ecstacy. — A deep trance, a condition analogous to catalepsy. 
The patient is insensible to all external impressions and is 
absorbed in the contemplation of some imaginary object. Eyes 
immovably fixed ; will give vent to grand thoughts, impassioned 
sentences, form a connecting link between the seen and the 
unseen, between heaven and earth ; fervent pra} T ers, beautiful 
hymns are recited with great fervency and zeal. It gives rise 
to a species of religious fanaticism, whereby the person (for filthy 
lucre) can fall into a trance, an incipient stage of spirit life, and 



DISEASES OF THE NERVOUS SYSTEM. 211 

give strange manifestations. It affects women mostly, or effemi- 
nate men who suffer from hysteria, or that peculiar devitalized 
state of nerve centres. Pecuniary gain, faith, imagination, 
enthusiasm, and an irresistible desire to imitate and become 
notorious, will explain the condition best. 
Same treatment as for Hysteria, 

CONVULSIONS. 

Spasms or convulsions consist of violent and involuntary 
contractions of muscles of the entire body, occurring in par- 
oxysms and usually attended with unconsciousness. Sometimes 
the contractions are partial and of considerable duration, and 
attended with hardness of affected muscles, (tonic spasm) like 
cramp or tetanus; in other cases quickly alternating contractions 
and relaxations (clonic spasm). 

Causes. — Disease of the brain or its membranes ; falls, blows ; 
insufficient supply of pure blood being sent to the brain or 
nerve centres ; to irritation reflected from gums in teething, 
worms, indigestible substances ; or to disease of kidneys, uraemia, 
pregnancy, masturbation ; morbid states of the blood, as in 
hydrophobia, fevers, hooping-cough ; to poisons, as well as to 
fright, passion, sudden mental emotion. 

Symptoms. — There are no warnings as in epilepsy. A part 
or the entire body may be affected, as the face, one-half the 
body or a single limb. Consciousness is generally but not always 
lost. During a paroxysm there is distortion of the features, 
pallor or lividity of the face and neck, staring or protruding eye- 
balls, insensibility of pupils to light, grinding and gnashing of 
teeth, protrusion of tongue, involuntary evacuations, laborious 
respiration. There may be only one attack or several, followed 
by a tendency to sleep. They are seldom fatal unless connected 
with some grave disease, as rabies or degeneration of kidneys. 
Convulsions of one limb, of face or half the body, not attended 
with loss of consciousness. Convulsions different from epilepsy, 
in the fact that there is no patch of the brain suffering a con- 
dition of molecular death, consequently there is no central cause 
keeping up a periodical attack. 

Treatment. — Loosen patient's clothes, especially about neck 
and waist. Place the patient wherever pure air can be breathed. 
Warm mustard bath and cold effusion to the head ; mustard 
plasters to limbs ; enemas of lobelia with turpentine, to be 
repeated if patient does not quickly recover. If an adult, cups 
to nape of neck ; if a child, apply ice. As soon as swallowing 
can be performed, compound lobelia to free emesis, followed by 
some active purgative. In children, compound liquorice pow- 
der ; in an adult, two drops of croton oil in fifteen grains of 
compound powder of jalap. The patient to be kept upon : 



212 DISEASES OF THE NERVOUS SYSTEM. 

Compound syrup lobelia, four ounces ; bromide of potassa, 
one ounce ; bicarbonate potassa, three drachms ; tincture cala- 
bar bean, half an ounce. — Mix. Doses sufficiently large and 
often to hold spasmodic action in abeyance. 

Cause, if possible, ascertained and removed. If the teeth, 
free scarification of gums ; if worms, santonine, etc. General 
tonics and alteratives if no cause can be ascertained. 

Puerperal Convulsions. — First try compound lobelia by 
enema and mouth, with a free action of bowels ; if that fails, 
a light inhalation of chloroform, followed at the same time with 
a hypodermic injection of a quarter of a grain of sulphate of 
morphia. If labor has not progressed and the convulsions are 
persistent, not broke up, induction of premature labor. If they 
come during parturition and not due to ergot, hasten delivery 
by forceps ; patient under anaesthetics. If ergot has been given, 
be careful of anaesthetics. If they occur after delivery and no 
ergot used, a free use of chloroform and hypodermic injections 
of sulphate of morphia; if ergot has been given, alkalies, bella- 
donna and compound lobelia to maintain perfect relaxation. 

Infantile Convulsions. — Attention to teeth, diet, bowels, 
worms; cold to head, ice to spine, warm bath, open bowels. 
Compound lobelia to emesis and afterward in small doses, fol- 
lowed with bromine. 

INSANITY. 

Sanity or a sound mind may be defined to be a condition in 
which a man can discharge his duty to his God, his neighbor 
and himself. Any deviation from that is regarded as insanity, 
or derangement of the intellect or mind. 

Causes. — Are very varied. Hereditary transmission of types 
or conformation and characteristics of cerebral pulp ; contrac- 
tion of the convolutions in the offspring of those who suffer 
from sameness, isolation, monotony ; marriage of blood rela- 
tions or persons identical in temperament ; want of brain ele- 
ments in diet — brain starves, defective nutrition. The brain 
of a father in whom the syphilitic germ lurks, or whose cere- 
brum is atrophied with alcohol, or whittled down by mastur- 
bation in early youth, or sexual excess in more advanced years, 
may stamp the impress of insanit}^ on his offspring. Besides, 
those causes may act directly on the individual, to which may 
be added tobacco, opium, chloral, quinine, poisons, the struggle 
for existence, the wear and tear of civilized existence, religion, 
blighted affections, passions, grief, anxiety, distress, injuries 
upon the head, want of sleep, over-exertion, excessive mental 
strain, blood diseases, irritation in different parts of the body 
transmitted to the brain, the action of the sun. 

Warnings. — Symptoms that should excite alarm are : severe 



DISEASES OF THE NERVOUS SYSTEM. 213 

arid frequent headache; giddiness and mental confusion; par- 
oxysms of irritability and loss of temper without any cause ; 
unfounded suspicions ; inability to perform usual avocations; 
weariness of life ; sleeplessness or lethargy; loss of memory; some 
decided deviation from usual line of conduct; defective articu- 
lation; impairment of sight; flightiness of manner; shuns society, 
often tortured with obscene thoughts ; has alarming dreams ; 
often suffers from dyspepsia. 

Complications. — Mental diseases are often accompanied with 
a variety of bodily disorders. Two of the most common of 
which are progressive paralysis of the insane and insanity with 
epilepsy. 

Forms. — As causes are not all alike, different forms have been 
marked, but they are apt to run into each other. We shall 
enumerate the most common varieties. 

(1.) Mania. — Stark mad, general delirium, reasoning faculty 
disturbed or confused, ideas erroneous, absurd, wandering, man- 
ner violent, excited, mischievous. It may come on suddenly 
or progressively, and is often preceded by neglect of family or 
business, distrust of best friends, anger, rage, despondency with- 
out cause, sleeplessness, constipation ; or without premonitory 
warning it may set in with general delirium and extreme fury, 
with shouting, howling, laughing, crying, reciting for hours 
together ; angry, furious, destructive, ceaseless movements, weak- 
ness, exhaustion, emaciation, aversion to food, incontinence of 
urine. Recovery, if it takes place, is preceded by sleep, with 
appetite returning and a gradual subsidence of the agitation 
and delirium. 

(2.) Monomania or partial insanity. Irrational on one sub- 
ject ; deranged to a certain degree, or is under the influence of 
some one particular delusion. Mind may be vigorous, but under 
the influence of one erroneous notion. Manner in accordance 
with the prominent idea. A false principle seized upon and 
pursued logically, and from which legitimate consequences are 
deduced. Thus, a monomaniac may conceive the idea that he 
is very brittle, and impressed with this idea takes remarkable 
care of himself. He may conceive the notion that he is a divine 
instrument of vengeance and commit murder. Aside from this 
partial delusion he will act like other men. 

There are numerous special forms of monomania, viz: 

Melancholia. — Characterized by fear, moroseness, despon- 
dency, an unwillingness to move, talk or take food. 

Autophomonomania. — One who desires to commit suicide, 
self-murder ; the desire to kill is so great that most extraordi- 
nary steps will be taken to effect his purpose. 

Androphomonomania. — An uncontrollable desire to com- 
mit murder. 



214 DISEASES OF THE NERVOUS SYSTEM. 

Pyromania. — Seized with a desire to set buildings on fire, to 
commit arson. 

Kleptomania. — Irresistible propensity to steal. 

Theomania. — Religious delusions. 

Erotomania. — Amatory madness; it may be a chaste and 
honorable affection, or it may be combined with nymphomania 
in women and satyriasis in men. In all forms of erotomania there 
is great mental and physical depression. Single women often 
suffer greatly. It is usually associated with disease of the genital 
organs or brain. 

(3.) Dementia. — That condition in which weakness of intel- 
lect, induced by accident or age, is the prominent feature. Mind 
feeble, ideas confused, vague wandering, memory greatly im- 
paired ; patient ignorant of time, place, quantity and property; 
very forgetful, undecided, selfish and silly. The demented have 
neither likes nor dislikes, affections nor aversions ; care for noth- 
ing. Paroxysms of restlessness and excitement; involuntary 
action of bladder and rectum ; terminates in paralysis. 

Acute Dementia may occur in the young from shock, 
anxiety; patient usually lies in bed, refuses food; mental faculties 
apparently in abeyance; pupils dilated; no control of sphinc- 
ters. Nourishment and moral influence are curative. 

(4.) Idiocy. — A partial or complete absence of intellect, 
owing to congenital malformation of the brain ; mind not 
developed; facial angle a little above a cipher; ideas simple 
or few; manners foolish, loathsome, disgusting; head misshaped; 
countenance vacant; articulation and gait often imperfect; saliva 
dribbling. Occasionally the idiot is blind, deaf, mute. 

We have stated that those four forms may be complicated, 
or terminate in epilepsy or paralysis. 

Insanity with Paralysis. — It may be progressive, partial 
or general. Paralytic lunatics seldom live over two years. The 
paralysis may come on in a person not previously insane, or in 
the course of any variety of mental disease, increasing as the 
power of the mind diminishes. Often the first indication is 
exaltation of ideas, the sufferer conceiving the idea that he is 
rich, strong or a wonderful person ; mental change ; impediment 
to movement of tongue ; convulsive trembling of lips ; articu- 
lation muffled and imperfect. As this impediment to speech 
increases, there comes on tottering, uncertain and vacillating 
movements in walking, handwriting changes ; a vacant look, 
intelligence and judgment lessened ; fits of irritability, hallu- 
cination and illusion ; loss of memory, debasement of moral 
character ; pulse frequent and feeble, small and long ; tongue 
on being protruded moves from one side to the other; pupils 
immensely dilated ; paralysis of sphincters, so that secretions 
are either retained or pass involuntarily; more generally the 



DISEASES OF THE NERVOUS SYSTEM. 215 

latter. As the disease progresses patients lose all power of articu- 
articulation ; they continually grind their teeth ; their weakness 
such that they cannot walk or stand, and all traces of intelli- 
gence become abolished, and the} T remain torpid and motionless. 

Insanity with Epilepsy. — Always incurable. The conduct 
of the epileptic insane is most ferocious, homicidal or suicidal. 
Filthy and disgusting in their habits. 

Treatment. — When any of the forms are suspected, rest of 
mind, change of occupation, sleep extended to ten or more 
hours; attention to the functions of the skin, bowels, liver, kid- 
neys and sexual system ; removal of any bodily disorder or 
disease, such as uterine derangement, syphilitic taint ; a very 
nutritious diet, warm clothing, out-door occupation or amuse- 
ment, cheerful recreation, healthy evacuations to be obtained 
from the bowels by vegetable alteratives and mild aperients. 
General strength to be improved by tonics. All bad habits, 
as onanism, to be prevented. Gentle attempts to revive affec- 
tions, strength, and build up intellect. Baths, as the douche, 
shower, warm or vapor, are of utility. If food is rejected, correct 
any derangement of the stomach. All harshness and mechanical 
restraint to be avoided if possible. An effort made to secure 
the patient's confidence ; every promise made to be faithfully 
kept, and as much indulgence as is consistent with the true 
management of the case allowed. The general treatment for 
chronic inflammation of the brain should be inculcated, and 
special remedies should have a fair trial. 

Bromide and chloral are of great efficacy; so is henbane for 
great restlessness. Calabar bean is of great service. The dose, 
to be effectual, must be large, out of all proportion to ordinary 
cases. 

Dipsomania. — An intense craving for stimulants, especially 
intoxicating liquors, attended with general restlessness, irrita- 
bility and sleeplessness. Hard drinking is a degrading vice ; 
the habit may be difficult to overcome, but we cannot accept 
the view that the dipsomaniac is an irresponsible being. 

Excessive use of alcohol causes atrophy, induration and anae- 
mia of brain, chronic inflammation of the stomach and thicken- 
ing of its walls ; fatty degeneration of liver and kidneys, dropsy, 
tubercle, and irritation of lower lobe of right lung and deposit 
of tubercle, pulmonary phthisis beginning at base and pro- 
gressing upward. 

If organic changes are not grave enough to bring about a 
fatal termination, a rapid cure can be effected by substituting 
erythroxylon coca for the whisky, which has no injurious effect 
upon either the mental or physical powers, but the opposite. 
A discontinuance of the alcohol and suitable doses of the ery- 
throxylon coca every hour effects a rapid revolution. 



216 DISEASES OF THE NERVOUS SYSTEM. 

Puerperal Mania. — A form of insanity occurring in women 
after delivery; usually of short duration, often four or five days. 
It is supposed to be caused by tedious, protracted or difficult 
labor, haemorrhage, embolism from ergot, worry, or depressed 
states of the vital forces. 

The ordinary symptoms are sleeplessness, restlessness, irrita- 
bility, with severe pain in the head, a diminution or arrest of 
the secretion of milk. In some cases fever; in others prostra- 
tion. Delirium often violent; tendency to suicide or child 
murder. 

If caused by exhaustion or haemorrhage, irritation reflected, 
support the brain and nervous system with quinine, juice of 
meat, and resort to hypodermic injections of sulphate of mor- 
phia; if due to congestion, embolism, dry cups to neck and 
spine, mustard to feet, free action of bowels, with liquor ammonia 
acetatis in alternation with tincture of belladonna. Patient 
kept quiet under the control of a skillful nurse. 

Erotomania. — Under which may be classed nymphomania 
in women and satyriasis in men. A mania for sexual congress, 
caused by excessive venery or masturbation. Morbid states of 
the clitoris, as hypertrophy, predispose to it, as well as elonga- 
tion of prepuce or foreskin. In very rare cases it may be due 
to irritation of spinal cord or disease of spine at the lower dorsal 
or upper lumbar vertebrae. This irritation is often the result 
of onanism in either sex. Disease of brain may be a cause, as 
extravasation of blood or lymph in the corpora cavernosa. 

Large doses of tincture of green root of gelseminum with bro- 
mide of potassa are very useful, with suppositories of belladonna 
and opium. 

SUICIDE. 

Suicidal mania is a peculiar morbid state of the brain of 
civilized man in which its typical fissures coalesce. A devia- 
tion from the normal type takes place termed atypic, which is 
present in hereditary insanity, and in the boy children of 
mothers who have exhausted their mental powers in literaiy 
pursuits, over-stimulating their nerve-power and thus causing 
a defective power of brain assimilation in their offspring. It is 
a low state of human brain in which the facial angle is lowered. 

Maternal impressions also give rise to it, as the witnessing of 
the slaughtering of cattle and killing of fowls ; the insatiable 
desire of some mothers during pregnancy to have criminal 
abortion performed, or in taking emmenagogue drugs to destroy 
and evacuate the contents of the uterus, thus impressing a sui- 
cidal disposition in her child. The true influence of our present 
trashy, demoralizing literature, can scarcely be adequately appre- 
ciated as a prolific cause; besides, we have most important factors 



DISEASES OF THE NERVOUS SYSTEM. 217 

in isolation, solitary confinement, masturbation and supposed 
loss of sexual power. The worry, the struggle for existence, is 
supposed to be a prominent cause ; but this is not correct, because 
suicide is more prevalent among the unmarried and the widowed 
than among the married, in whom the struggle is greatest. The 
anaemia of the brain and cord induced by excess of study and 
sexual losses is an important factor. Infidelity, Darwinism have 
an important bearing in its production. 

It is also to be regarded as epidemic. There is a singular 
regularity of the law which governs the return of suicides. 
The regularity is conclusive. There is a perfect uniformity 
with which the numbers of suicides are repeated from year to 
year in each country, especially in those countries in which 
the rate of suicides is high, such as France, Germany, England 
and the United States. Side by side with this remarkable regu- 
larity is a progressive increase of this morbid condition during 
recent years in the above-named countries. 

It has, besides, a seasonal distribution, the first months of the 
year being few, but a steady increase to June, when it is at its 
height, and from its maximum there is a steady decline to the 
end of the year. The variations in the prevalence of suicide 
in different localities depends a good deal on their moral, social 
and religious status and absence of monotony. The influence 
of sound, honest Christianity (no sham) retards it. In Scotland, 
where the rigid Presbyterian has a hold ; in Ireland, Spain and 
Portugal, where Catholicism is pure, the affection is rare. The 
number of suicides increase in countries where religion is a 
mere show or trade-mark. The proportion of suicides to the 
population is less where the tenets of the Bible are absolute, 
whereas the largest proportion occur where infidelity is ram- 
pant, as in Germany and the United States. In Europe the pure 
Germanic race show the highest proportion of suicides, followed 
closely by the Scandinavian races; whereas, among the Latin 
race, all except France, the rate is low, in Russia seldom 
known. 

In the present state of pathological anatomy, the old theory 
of suicide being the effect of the struggle for existence and of 
human selection, which works according to the laws of evolution 
among civilized people, will not stand good. The proportionate 
relation between male and female suicides is pretty constantly 
from three to four males to one female. The pioportion of 
suicides is largest between forty-five and fifty-five, very few 
taking place later in life. 

The humanizing effects of an implicit faith in God, of man 
being part and parcel of that immortal existence, and of end- 
less immortality well grounded into a people, seems to be the 
best prophylactic. 



218 DISEASES OF THE NERVOUS SYSTEM. 

NIGHT-MARE. 

This is a peculiar condition of the nerve centres, consisting 
in a true anaemia of the brain and sympathetic system. It is 
impossible to locate it precisely, although the co-ordinating 
chemical centre at the base of the brain is chiefly affected. 

The exciting causes are indigestion, debility, late and heavy 
suppers, great fatigue, worry, over-study, breathing impure air, 
sewer gas, badly ventilated room, intoxication, sleeping on back, 
food indigestible, anything that would be likely to load the 
blood with any impurity. 

Symptoms. — The patient in sleep feels an oppression, a 
weight about the stomach and breast ; he groans, is in great 
distress, dreads suffocation ; he fancies himself in imminent 
danger, and tries to escape, but cannot move; he imagines him- 
self about to fall over a precipice, to be drawn into a river or 
eaten by wild beasts, or consumed in a burning house, etc., etc. 

Treatment. — The affected person should eat a very light 
supper or none at all ; keep the mind free from care and anxiety; 
no study; have a well-ventilated room to sleep in, free from 
gases, growing flowers ; must sleep on right side ; have a daily 
bath and massage ; bowels to be well regulated and abundance 
of exercise in the open air. 

It is to be looked upon as a true condition of cerebral debility, 
so the diet is to be essentially of a brain-nourishing kind : oat- 
meal porridge, boiled white fish, animal food, steaks, chops, 
poultry, eggs, corn bread, fruit and vegetables. He must eat 
no pies, pastry, cabbage, nuts, salted meat or fish, nor no red 
fish, like salmon, for that abounds in oil, and although very 
stimulating and nutritious is heavy and does not agree well 
with a weak stomach. 

As remedies, glycerite of ozone, kephaline, aromatic sulphuric 
acid and quinine, and other tonics. 

HOME-SICKNESS. 

The Anglo-Saxon are the most cosmopolitan of races, adapt- 
ing himself to almost any country and climate on the globe; 
but he cannot do this in all countries and with impunity, for 
in some he is compelled to exercise a care incompatible with 
actual work, which condition renders him a mere cipher. The 
North American continent is perhaps the most noted example 
of a country in which all races seem to thrive to perfection. 

Man has an affinity for the spot of earth on which he origi- 
nated and on which his ancestors were raised, an indigenous 
faculty, a cohesive or homogenous principle that enables him 
to thrive better, live longer and ward off disease more effectually 
than if he were transplanted to a new or foreign soil. So great 
is this innate faculty in some families that if they migrate they 



DISEASES OF THE NERVOUS SYSTEM. 219 

become sufferers from a peculiar train of nervous symptoms, until 
the law of habit and affinity take their place. The ungratified 
desire to return home may give rise to a long train of symptoms 
of which melancholia is the most prominent. Great bodily and 
mental debility and depression ; loss of appetite, inability to 
procure sound sleep. In some cases there is a gradual wasting 
of the body, with delirium, fatal prostration and other diseases. 
These are usually overcome by kind treatment, exercise in the 
open air, change of scene, amusement, nourishing diet, baths, 
warm clothing, regulated secretions and remedies to procure 
sleep. If all fail, a temporary return home usually effects instant 
relief. 

The home-sick suffer from a thousand inconveniences and are 
very liable to take on disease especially of a nervous type, which 
give rise to habits that are deleterious to his future welfare and 
progress in life. Of the various families of the white race the 
Celts suffer most in climatizing. There is more repugnance in 
the race to fix its stock upon a foreign soil than with the others. 

TETANUS, OR REFLEX ACTION. 

Of all diseases of the nervous system there is none so appal- 
ling as tetanus. The power of the medulla oblongata to receive 
irritation from a distant point and to have it indelibl} T fixed 
there,, is an interesting study. An irritation of gray or sentient 
nerve tissue in any part of the body, which irritation is trans- 
mitted to the medulla oblongata, setting up an irritation there 
similiar in kind and degree, which, if its intensity is sufficient, 
is reflected back by the white, fibrous or motor nerves that sup- 
ply the muscles, which causes a contraction or spasm. It is 
necessary that there be an impairment of vital force and that 
the irritation be vital, such as a laceration or tear, or bruising 
of a nerve. Slight or low grades of irritation simply depress 
or enfeeble the medulla — the seat of life, causing a defect in 
nutrition or a degradation of elementary molecules — such a 
condition as tubercular 

Irritation, great in kind or degree, reflected according to this 
reflex law, setting up the same kind or condition in the medulla 
and from thence reflected back by the muscles, which cause 
long-continued contraction or spasm. The spasm being con- 
tinuous and hence spoken of as a tonic spasm or spastic contrac- 
tion, in contradistinction to the clonic spasms of convulsions, 
where there are ultimate contractions and relaxations. 

Causes. — A tear or laceration of a nerve or its neurilemma, 
such as a lacerated wound, a tooth merging through the indu- 
rated gums; a worm nibbling at the periphery of a sentient 
nerve in the bowels; the presence of the head upon the sacral 
plexus of nerves in labor. When from a wound it is called 



220 DISEASES OF THE NERVOUS SYSTEM. 

traumatic; when from internal irritation, like a worm, or in- 
vaginated bowel, idiopathic. 

Symptoms. — When an attack takes place it usually sets in 
very suddenly. Muscles of the jaws and throat are first affected. 
Patient complains that he has taken eold, as if he had a sore 
throat or stiff neck ; but stiffness and uneasiness soon increase 
and extend to the root of the tongue, causing difficulty in swal- 
lowing. The temporal and masseter muscles gradually become 
involved, so that the jaws become fixed and mouth firmly closed, 
thus giving us what is termed trismus, or lockjaw, As the entire 
spinal cord is a reflex centre as well as the medulla, if the irrita- 
tion proceeds down the cord, the remaining muscles of the face, 
trunk and extremities become involved in the spasm. Angles 
of mouth drawn outwards and upwards; muscles of neck, back 
and abdomen, hard, tense, contracted and from time to time 
violent contractions occur. Spasms never entirely cease, except 
in some cases during sleep ; aggravated every quarter of an 
hour or so, increased, cramps lasting for a few minutes and then 
partially subsiding. When the nerves that supply the strong 
muscles of the back are most implicated or affected, they draw 
or bind the body in the shape of an arch, the patient resting 
on the occiput and heels, which is called opisthotonos. If the 
nerves that supply the anterior or front muscles of the body 
are weakened by any cause, the irritation may exhibit or spend 
itself there and thus bend the body forward by strong contrac- 
tions of the muscles of the neck and abdomen; this is called 
emprosthotonos. If the nerves that supply the muscles on either 
side be affected or weakened, the irritation may spend itself 
there and the body be drawn sideways, which has been desig- 
nated pleurosthotonos. By and by, the nerves that supply the 
involuntary muscles become affected. Frightful suffering, caused 
by tetanic spasms; face pale or as white as snow; brows con- 
tracted ; skin covering forehead corrugated ; eyes fixed and 
prominent, sometimes suffused with tears ; nostrils dilated ; 
corners of mouth drawn back ; teeth exposed and features fixed 
in a grin — risus sardonicus. Respiration performed with diffi- 
culty and anguish ; severe pain at the sternum or pit of the 
stomach; great thirst, but agony increased by attempts at deglu- 
tition; pulse feeble and frequent; temperature very slightly 
raised ; skin covered with perspiration ; patient cannot sleep, 
or if he does, it is only for a few minutes at a time. In spite of 
all the suffering the patient's intellect remains clear and unaf- 
fected. It terminates either in death or recovery, or by a break- 
ing up of the spasm into chronic, from which, with proper 
management, recovery is almost certain. 

The duration of an acute attack is usually between three and 
five days, death taking place partly from suffocation, partly 



DISEASES OF THE NERVOUS SYSTEM. 221 

from exhaustion. It is very easily recognized by its history 
and symptoms, the absence of fever, the clearness of intellect 
and the continued spasm. No other disease like it. The appear- 
ances after death are great serous effusion in ventricles of brain, 
around the spinal cord ; the whiteness of skin and laceration 
of muscles by the spasm is also present. 

Treatment. — If possible move the bowels freely with com- 
pound powder of jalap and senna with one drop of croton oil. 
Apply at once the galvanic cautery at a white heat every three 
quarters of an inch on both sides of the spine, from the nape 
of the neck down about ten inches. After its thorough appli- 
cation, poultices composed of equal parts of flaxseed meal, pul- 
verized lobelia and stramonium, should be applied as hot as can 
be borne and changed every three hours. While this is being 
done, an effort must be made to relax the spasm, as the recovery 
of the patient depends upon that. For that purpose, take one 
heaped teaspoonful of lobelia seed, fresh crushed, one teaspoonful 
of the fresh plant of lobelia, one tablespoonful of American vale- 
rian, and one tablespoonful of pulverized capsicum : place all 
in half a pint of brandy, shake well, let it settle a few minutes, 
then begin to give a teaspoonful every few minutes until the 
spasm relaxes. If there is a hot bath handy, put the patient 
in it (97° Fahr.) Throw in the bath a pound of lobelia, and 
while in the bath enemas of a strong infusion of lobelia should 
be given. The lobelia, by the stomach, bath and rectum should 
be pushed to thorough relaxation of spasm, avoiding emesis if 
possible. If there are no facilities for a hot bath, then cloths 
wrung out of a decoction of lobelia should be applied to chest, 
abdomen, thighs. Half an hour is sufficient for the bath, but 
if cloths are applied they should be constantly used, keeping 
them hot and moist. If spasm breaks, the case may be con- 
sidered pretty safe, if well managed. The moment the patient 
can swallow give thirty grains of bromide of potash every two 
hours, with five grains of bicarbonate in a tablespoonful of cam- 
phor water or fluid extract of sumbul ; in alternation with that, 
administer from half a teasjDoonful to a whole teaspoonful every 
two hours of the tincture of calabar bean, at the same time 
continuing the lobelia mixture in small doses or less frequent 
intervals. In this way make an effort to carry the patient over 
the fifth day, paying proper attention to diet, the bowels and 
bladder. 

If there is a wound or some irritating body in the tissues, the 
wound should be carefully attended to ; irritating particles such 
as spicula of bone or other bodies removed ; the nerve, if lacerated 
or torn, might be divided and poultices of lobelia and stramo- 
nium applied. Otherwise the wound should be treated on 
general principles. There is no use in dividing the nerves high 



222 DISEASES OF THE NERVOUS SYSTEM. 

up in the limb ; no use even in amputation, for when the irri- 
tation is once stamped on the medulla oblongata, it is perma- 
nent ; so that the true treatment is to diminish or wipe out the 
irritation of the cerebrospinal axis all through the case. In 
no case would it be safe to discontinue the use of those three 
remedies, lobelia, bromide of potassa and caiabar bean, for three 
or four weeks. The quantity and frequency could be gradually 
diminished. 

Spasm well broke between fifth and tenth day, aconite, bella- 
donna, quinine, conium might be tried. 

If there seems to be any septic or rnorbid matter absorbed, 
sulphurous acid or sulphite of soda should be given. 

Remedies that are positively injurious and likely to cause death: 
inhalation of ether, chloroform ; hypodermic injections of any 
kind, opium or its alkaloids positively injurious ; chloral, hurt- 
ful; those and other remedies of the same class produce con- 
gestion and polar excitement of the spinal cord. 

Trismus Nascentum. — Infantile tetanus, nine-day fits. Teta- 
nus occurring in infants after birth, from cutting the cord with 
blunt scissors, irritating applications to the navel, as trichinous 
lard, etc. Very rare in this country. Nevertheless, great care 
is necessary to guard new-born children from cold, foul air, 
poisoned lard to skin, imperfect cleaning of sebaceous secretion, 
or from retention of meconium. Cord should be properly cared 
for; never left in charge of an ignorant nurse, — invariably 
fatal. 

Puerperal Tetanus may make its appearance during or sub- 
sequent to labor. Pressure of the foetal head upon the sacral 
plexus of nerves is the common cause, which irritation is re- 
flected to the medulla oblongata causing the peculiar changes 
there, which irritation is transmitted by the motor nerves that 
supply the muscles, hence the permanent rigid spasm.- It is 
well to observe that the true symptoms are developed, because 
in the puerperal state we have conditions of spasm dependent 
upon enemia or congestion, that require a different mode of 
treatment. The mode of management here is to deliver as 
rapidly as possible, administer the lobelia mixture by mouth 
and rectum, follow with bromide of potass, calabar bean ; sina- 
pisms to nape of neck, with mustard and free purgation. In 
all respects the treatment is the same as for general tetanus ; 
we, however, seldom use the galvanic cautery, or hot bath, or 
packs. 

Other Methods of Treatment sometimes used, but with 
poor success, as inhalations of nitrite of amyl, calomel, atropia, 
hvpodermically. Nicotine; prolonged application of ice to 
spine; glonoin, aconite. 



DISEASES OF THE NERVOUS SYSTEM. 223 

SPINAL MYELITIS. 

Inflammation of the substance of the spinal cord is a rare 
affection, usually a segment or portion involved, seldom the 
entire length. 

It may be caused by blows, falls, shocks, concussions or to 
disease of the vertebrae. Sometimes co-exists with other dis- 
eases, and in some cases seems to be dependant on them, as 
syphilis,, mercury and some fevers. 

Symptoms will depend almost entirely upon what part of 
the cord is implicated. If the cranial portion of the cord is af- 
fected, there is deep-seated headache; convulsive movements 
of head and face ; inarticulate speech ; trismus ; difficult deglu- 
tition; impeded spasmodic breathing; irregular action of heart; 
paralysis. If about to prove fatal in the acute stage, great 
prostration; greater difficulty of breathing; involuntary excre- 
tions. When the entire thickness of the cord above the phre- 
nic nerve is affected, death takes place rapidly from cessation 
of respiratory movements. If the cervical portion suffer inflam- 
mation, difficulty in swallowing and breathing ; impossibility 
of raising the head, pain in back of neck ; sense of pricking 
and formication in arms and hands ; paralysis of upper extre- 
mities. If the dorsal, pain over the affected part, numbness or 
pricking sensations in fingers and toes; paralysis of arms and 
lower extremities, with great difficulty of breathing and palpi- 
tation. If the lumbar, marked paralysis of lower extremities, 
at an early period, abdominal pain, and a sensation as if there 
were a cord tight around the body, convulsions with retention, 
followed by incontinence of urine, owing to paralysis of blad- 
der, involuntary stools followed by paralysis of sphincter ani. 
Pain in whatever part is increased by heat, pressure or move- 
ment. The loss of power in lower limbs and body below the 
seat of inflammation, and later, of sensation. 

In the treatment, the cause must be removed if possible ; if the 
disease is due to syphilis or mercury, iodide potass. Locally, 
galvanic cautery, iollowed with poultices of belladonna. Con- 
trol fever with aconite, veratrum and belladonna internally, 
any convulsive movements with comp. lobelia and bromide of 
potass. In all cases due attention to bowels and bladder other- 
wise, general treatment. 

If we are even able to tide the patient over an acute attack 
into chronic myelitis; we may even then meet with success. 

Chronic Inflammation of spinal cord may be a sequel of 
an acute attack, or it may arise from the same causes, or it may 
occur in persons of feeble health, after middle life. Pain or 
pressure, on movement and on the application of a hot sponge 
or the pole of a galvanic battery, aching in the back and limbs 



224 DISEASES OF THE NERVOUS SYSTEM. 

and gradual loss of power of lower extremities. Symptoms 
most marked in the morning, the congestion being favored by 
the recumbent posture. 

Chronic inflammation may terminate in thickening and soft- 
ening with atrophic degeneration. 

Then in addition to the above symptoms, there will be numb- 
ness, and coldness and loss of sensation, as well as motion. If 
the anterior columns only are affected, motor paralysis pre- 
vails ; if the posterior columns, sensibility is impaired or de- 
stroyed. 

Recovery from spinal softening is very rare, and only to be 
attained by rigid and thorough treatment and promoting the 
general health. If decided paralysis be present with involun- 
tary urination and defecation, with a copious deposit of phos- 
phates and chlorides, the case is most unfavorable. The treat- 
ment embraces attention to diet, to consist of an excess of that 
which is termed phosphatic, oatmeal mush or cake, boiled fish, 
wheaten grits, corn-cake ; otherwise generous and varied animal 
food, eggs, cream ; to the almost continuous application of irri- 
tating plaster to both sides of spine; to baths, alkaline and 
medicated, with friction, shampooing, electricity; to an erect 
posture, and to alteratives and tonics : such alteratives as ozonized 
compound syrup phytolacca, ozonized glycerine, iodine, bro- 
mine, etc., and such tonics as ozone-water, cinchona, nux, rhus. 

SPINAL MENINGITIS. 

Inflammation of the membranes of the spinal cord is not 
very common, as the cord is well protected from all external 
violence, as shocks, concussions, mechanical violence, exposure 
to wet or cold in rheumatic subjects ; nevertheless, these causes 
often produce it. Such poisons as strychnine, if carelessly 
administered, are productive of it. When vital force is very 
low, as we often see in crowded abodes or among the inmates 
of our so-called benevolent institutions, where diet is meagre 
or unfit for human food, we have a degradation of normal living 
matter into a disease-germ, the oidium albicans, which instead 
of localizing itself on mucous membrane as in diphtheria, selects 
as a location or abode the highly organized structure of the 
living membrane or covering of the cerebro-spinal axis, pro- 
ducing what is termed epidemic cerebro-spinal meningitis or 
spotted fever. 

Symptoms are the same as cerebro-spinal meningitis if high 
up. Generally they consist of a rigor or a fever, acute burning, 
or often sharp lancinating pain along the spine extending to 
the limbs, aggravated by pressure and movement, resembling 
rheumatism. If high up, there is opisthotonos; head thrown 
back witli rigidity of the muscles of the neck and back; feeble- 



DISEASES OF THE NERVOUS SYSTEM. 225 

ness of limbs, often paralysis and loss of power increases as the 
case progresses ; sensation of suffocation ; feeling of constriction 
in neck, back or abdomen ; if lower down, retention of urine, 
constipation, priapism; great prostration; if morbid action pro- 
ceed; delirium, coma, death. 

A large number of our fevers, when occurring among the 
broken-down part of humanity, terminate fatally in spinal 
meningitis. The proper treatment should consist in the free 
use of the galvanic cautery to both sides of spine, above and 
below affected part, followed with hot poultices of flaxseed meal 
and glycerine. General treatment for fever, aconite and vera- 
trum viride, free action of bowels, attention to bladder; bathing 
thrice daily, heat to feet, tepid water to head; large doses of 
tincture of calabar bean and bromide of potassa. same as in 
Tetanus. If there is spasm or contraction of muscles, a free use 
of equal parts of lobelia, capsicum and valerian. Nutrition 
above all things to be seen to; juice of raw meat, eggs, milk. 
If it exhibits the form due to a disease-germ, antiseptics, same 
as in Typhoid Fever, carbolic acid and tincture of iodine, ozone- 
water. 

SPINAL HEMORRHAGE. 

Effusion of blood into the cord may take place at any part, 
and in a small or great degree, either in its substance or from 
its membranes. It may be a result of active inflammation or 
of concussions, blows, falls, over-exertion, degeneration of coats 
of blood-vessels, caries of the vertebrae. 

The Symptoms will vary according to the seat of lesion. 
Acute and sudden pain in back, sometimes in head ; often severe 
convulsions : difficult breathing if high up, with heart's action 
depressed, with pale and cold skin; if not high up, conscious- 
ness not impaired, the spasm then being confined to limbs. 
Effusion into substance of cord produces paralysis in all parts 
supplied with nerves coming off below its seat. If haemorrhage 
be very slight, loss of power occurs slowly. If effusion is sus- 
pected, a further amount is to be checked by perfect repose and 
application of ice in an intestine along the spinal column. 
Subsequently, the galvanic cautery followed by poultices, the 
faces of which are covered with aconite and belladonna lini- 
ment. Large doses of bromide of potassa and calabar bean 
with general alteratives and tonics, guarding all points very 
carefully. 

SPINAL TUMORS OR INDURATIONS. 

Irritation of all kinds, falls, blows, strains, lifts, anything we 
can imagine that would weaken any portion of the cord or its 
membranes, may permit of effusion of lymph which produces 

27 



226 DISEASES OF THE NERVOUS SYSTEM. 

thickening, or if the blood of the patient is highly loaded with 
the germs of the tubercle, cancer, syphilis, rabies, they may 
form a nidus or seat of deposit, and grow and multiply, giving 
rise to a nodule of tubercle, an exostosis of syphilis, a cancerous 
infiltration, and may thus, by causing pressure or producing 
atrophy, cause paralysis. 

Symptoms come on slowly but progressively. Paralysis of 
motion precedes that of sensation, often not very decided till 
growth or infiltration is some size. Apt to be pain over seat of 
induration, cramps and convulsive movements of the extremities. 
Nature of tumor or thickening is to be inferred from the his- 
tory of case and diathesis of patient. 

Treatment. — General health to be well cared for ; nutritious 
brain diet; bathing with frictions and inunctions of oil into 
paralyzed limbs ; attention to secretions. Persistent use of altera- 
tives and tonics, iodide potassa, tincture iodine, iodide of starch 
and lime, with vegetable alteratives, as phytolacca compound, 
and such tonics as quinine, mineral acids, occasionally ergot; 
bitter tonics, as kurchicine, gentian, and above all things the 
unremitting application of a two-inch wide strip irritating plas- 
ter on both sides of the spine, changed every morning; keeping 
up a free, copious discharge of pus. Firm, determined perse- 
verance will often get rid of the difficulty. 

SPINAL IRRITATION. 

The medulla oblongata is, properly speaking, the seat of 
reflex action ; but all nerves originating in both brain and spinal 
cord have, as it were, a common connection more or less with 
the medulla, the bulb of which seems to be the common source 
or fountain of nerve supply, the spinal cord being but its pro- 
longation, not so highly organized as the medulla but neverthe- 
less a reflex center from bulb to sacrum. The theory upon 
which spinal irritation is based is, that all irritations of any 
organ are transmitted to the root or origin of the nerve or nerves 
that supply it; in other words, the same kind or intensity of 
irritation exists at the nerve that exists in its periphery or 
terminal end in the affected organ ; that when the disease of 
the organ is removed it is still necessary to wipe out the irrita- 
tion at the root of the nerve in the cord, else a recurrence is to 
be expected. 

The Canse is any irritation in chest or abdomen or extremi- 
ties, but especially the viscera in the abdomen with its complex 
genito-urinary system. The disease is most frequently met with 
in women and in young men addicted to masturbation, although 
quite common in chronic disease generally. 

Symptoms. — There is pain localized in some part of the spinal 
cord which can easily be detected by pressure, movement, or 



DISEASES OF THE NERVOUS SYSTEM. 227 

by a cloth wrung out of hot water hurriedly rubbed down the 
spine, or the sponge of an electrode when current is running. This 
may be complicated with neuralgia or spasmodic affection involv- 
ing the organs supplied with spinal nerves. If the irritation 
is on the dorsal portion it is generally referred to one side, fre- 
quently the left, and is only felt below the mammae, often com- 
plained of as a constriction or tightness or suffocation, with 
accelerated action of the heart, with spasmodic cough. If the 
irritation is in the lumbar, there will be spasmodic action of 
the viscera ; numbness, cramps and excessive tenderness, with 
impaired motion and sensation in the lower extremities, with 
constipation, retention of urine, irritable bladder and uterus, 
with disturbed menstruation. 

It is not common in the cervical portion, still if it took place 
there it would give rise to neuralgic pains in the neck and face, 
difficulty of swallowing, loss or impairment of voice and affec- 
tion of speech, cough and altered sensibility; partial paralysis ; 
coldness and numbness of both hands or a pricking sensation. 
In addition to these local symptoms the patient assumes or 
acquires a strong nervous temperament; suffers from a good 
deal of nervous prostration, headache, dyspepsia, etc. 

In the treatment, attention to the bowels, bladder and skin ; 
daily bathing followed by brisk friction ; moderate exercise in 
open air if strength permits, and when not exercising rest in the 
recumbent posture ; tonics to strengthen stomach and improve 
appetite. Diet to be generous and rich in brain elements. The 
cause must be removed and any blood affection seen to. Then 
the special treatment for the relief of the irritation resorted to. 
This will embrace local stimulation in some form. The best is 
probably a two-inch strip of irritating plaster on both sides of 
spine, spread fresh every morning and applied continuously if 
possible; if not, as much as can possibly be endured. If this 
is not to be tolerated, then daily frictions or inunctions with 
some of the following liniments : 

Olive oil, two ounces; chloroform, one ounce; alcohol, one 
ounce and a half; thymol or menthol, one ounce. — Mix. Or, 
equal parts of tincture of aconite, belladonna, chloroform and 
aqua-ammonia. If there is some objection to this, then use 
of the acupuncturator along both sides of the spine, in no case 
deep enough to draw blood, every other day followed with oil 
of mustard and chloroform, which has a most salutary action. 
The electrical brush for a half an hour each alternate day also 
operates well. One or other of these methods must be com- 
menced and carried vigorously out. 

As long as pain exists, the bromide and iodide of potassa with 
carbonate of ammonia, with tincture of calabar bean should be 
given in such doses as will do some service. Then a general 



228 DISEASES OP THE NERVOUS SYSTEM. 

alterative and tonic course of treatment bearing on the cause 
of the complaint. In spinal irritation we have an immense 
range of remedies that act well in causing a renewal of life in 
the cord. 

Among our best alteratives are ozonized glycerine, iodide and 
bromide in compound syrup of caulophyllin. Among tonics, 
phosphate of quinine, ozone-water, aconite, belladonna, ergot, 
mineral acids, calabar bean. 

CHOREA. 

This disease is recognized by a want of control of the mus- 
cular nerves over the motor, in the waking state, which gives 
rise to irregular, tremulous, and ludicrous movements of the 
voluntary muscles. It occurs for the most part in girls of fee- 
ble constitution ; of an irritable, nervous temperament, between 
the ages of five and fifteen. It is met with more rarely in 
boys. 

Causes. — It is supposed to originate in a jar, or want of 
harmony between the gray and white matter of the spinal 
cord, probably brought about by falls, blows, shocks of various 
kinds actiog upon a weakened cord and bulb. More active, 
exciting causes are anaemia and other blood diseases ; teething, 
worms, dyspepsia, skin eruptions, retarded catamenia, consti- 
pation, cold, insufficient food, excessive loss of blood, pregnancy, 
disease of bladder, rectum, mental emotion, passion, masturba- 
tion, and other reflex conditions. 

Symptoms.— The commencement of this disease is character- 
ized by nervous depression and debility. The involuntary 
motions begin by slight twitching of the muscles of the face ; 
then other muscles become affected, and one or more limbs ; 
features often curiously contorted and twisted; vacancy of 
countenance ; articulation impeded ; appetite irregular, often 
constipation ; generally one-half of the body more affected than 
the other. Irregular action ceases during sleep. The disease 
may last for a lifetime and produce no bad results, whereas in 
other cases the nervous system becomes impaired and there is 
a rapid breaking down. It produces difficulty of respiration 
and retards the functions of the heart. It is apt to be attended 
with danger. 

Treatment. — In the treatment of all cases of chorea, a com- 
plete change of habits and occupation, and a resort to the fresh 
air of the country; abundance of exercise, and a very generous 
diet, together with daily baths and friction to skin, are indis- 
pensable. The closest scrutiny of the case, as to whether there 
be any blood affection, or reflex irritation, especially of the 
genito-urinary organs. All causes must be removed, if possi- 
ble, and a special treatment inculcated for each ; the secretions 



DISEASES OF THE NERVOUS SYSTEM. 229 

well stimulated. The great impressibility of the nerve-centres 
must be seen to by the daily application of stimulants to each 
side of the spinal cord, as friction with stimulating liniments, 
or acupuncturator, the irritating plaster, ice, or use of menthol ; 
some one of these selected, and, internally, bromide, calabar 
bean, sumbul. These latter not only relieve the impressibility 
of the cord to reflex action, but help to control the involuntary 
movements : 

Camphor-water, four ounces ; bromide potassa, one ounce ; 
carbonate ammonia, half an ounce ; tincture calabar bean, one 
ounce. — Mix. From a half to one teaspoonful every three hours, 

If retarded menstruation be the cause, in addition use com- 
pound betin and acetated tincture of iron. 

If worms, the usual remedies. 

If fright, terror, mental distress, stramonium, belladonna, 
macrotys, nux vomica. 

If uterine irritation, macrotys, viburnum, Indian hemp. 

If rheumatism, colchicum, phosphate of quinine, salicylate 
soda, iodide potassa. 

If due to blood-poison, or disease-germs, special treatment, 
according to cause. Other remedies sometimes successful, as 
sulphate of analine, nitroglycerine. 

ANJEMIA OF THE BRAIN, SPINAL CORD, GANG- 
LIONIC SYSTEM AND GREAT SYMPATHETIC. 

The term anaemia, meaning bloodless, or want of nutrition, 
is often applied to tissues or organs when their vitality is 
impaired, irrespective of any disease of the blood, such as 
anaemia of a nerve in neuralgia, a starved heart in rheumatism 
and gout ; atrophy of a muscle, owing to an insufficient blood 
supply; anaemia of the uterus, etc. In cerebral anaemia the 
quantity of blood in the brain is reduced below the natural 
standard, or the quality of the circulating fluid is impoverished. 
In either case the nutrition of the organ is interfered with. 
In the one case there may be a loss of blood, or the blood can- 
not permeate the nerve-centres, or there may be a lack of blood 
formation. Insufficient nutrition is the cause of anaemia of 
the brain, spinal cord and sympathetic, and this may be brought 
about by worry or struggle for existence, or it may be due 
to insomnia, to sameness, monotony, isolation, or to irritation 
reflected, to diseases within the body, or to disorders of diges- 
tion or assimilation interfering with nutrition. It is well known 
that under a condition of worry, sorrow, grief or other depressing 
passion, the blood becomes poor in quantity and quality from 
deficient nerve supply, and is unfit to nourish the brain, and 
the great centres suffer from the shock incidental thereto as well 
as from poor blood, and with it the whole body suffers. 



230 DISEASES OF THE NERVOUS SYSTEM. 

In cerebral anaemia from impoverished nutrition, there is 
not only a decrease in the red corpuscles of the blood, but the 
power of the heart and blood-vessels is lowered ; there is a defi- 
ciency of the functional energy of all organs, due to a want of 
blood and innervation ; strength of will, vigor of intellect and 
the vital capacity of execution and determination are impaired, 
and the individual is capable of no effort. The mental inertia 
or depression is generally accompanied with lassitude and a 
feeling of utter incapacity for muscular and mental exertion of 
any kind. 

The causes of ansemia of the nerve-centres are very varied, 
and embrace to a certain extent a long list of diseases, such as 
concussions, the action of the sun, chronic inflammation, soften- 
ing; the action of whisky, opium, chloral, tobacco; mania, 
monomania, dementia, melancholia, nervous dyspepsia, hys- 
teria, epilepsy, catalepsy, ecstacy, somnambulism, paralysis, con- 
vulsions, headaches, etc., in addition to worry, tire, exhaustion, 
study, mental strain incessant; masturbation, sexual excesses, 
deteriorating influences of civilization, over-stimulating the 
nerve power; defective assimilation of brain elements, improper 
reading, deleterious trades; solitariness or sameness, which wipe 
out the typical fissures of the brain and thus lowers its quality; 
too early an education, which causes a defective power of assimi- 
lation in the brain, protracted inhalation of air deficient in 
oxygen, whereby the centres are not vitalized. Nerve tire; to 
which may be added civilization, refinement, culture, which 
create new and abnormal responsibilities, new anxieties, every 
one of which brings on additional mental strain. The mind 
of highly civilized man is ever on the alert. The brain has no 
rest; nutrition of other tissues is diverted to repair the waste 
of nerve-tissue, and sooner or later inevitably comes the anaemia 
or exhaustion. It is undeniable that anaemia of nerve-centres 
increases with civilization, and that diseases of the brain, spinal 
cord and ganglionic nerves are alarmingly on the increase. 

Among the most prominent of these causes is worry, struggle, 
real or imaginary; this gives rise to a grave loss of nervous 
energy and anaemia of nerve-centres. By it the united brain, 
in tone, strength, capacity is seriously impaired ; by its wearying, 
gnawing, exhausting influence, the organ is devitalized and irre- 
trievably suffers ; by it the whole machinery is thrown out of gear, 
and exercise, recreation and amusement become painful and 
destructive. The victim of worry is on a precipice ; if he escapes, 
it is something providential. Worry is disorder, and nature 
abhors it. The energy employed in any pursuit under a state 
of worry gives a small result and speedily becomes exhausted. 
Under it the faculty of recuperation is arrested; the failure of 
the appetite soon takes place and the effort to work is laborious; 



DISEASES OP THE NERVOUS SYSTEM. 231 

the task of fixing the attention grows increasingly more difficult ; 
thoughts wander; memory fails; reason becomes feeble; preju- 
dice takes the place of judgment; brain disturbance very apt to 
supervene and a crash is likely to follow, with mental disquietude 
and distraction. 

Next to worry we have mental strain , incessant attention for 
hours in bank officers, railroad employees, merchants, etc. No 
one who has any practical acquaintance with the human brain 
can fail to recognize the fatuity of a policy which entrusts the 
safety of their lives and fortunes to the integrity and precision 
of the mental function performed by one brain, continuously 
engaged for several hours in succession — the keeping of the 
brain on the stretch for long intervals; the sustained attention 
of onerous duties weakens its integrity and it becomes anaemic. 
In the nature of things, physical memory fails; mind wanders; 
and if it were not for habit, the task probably could not be per- 
formed. The higher cerebral centres are relieved by the strain 
put upon them by delegating their power to the lower auto- 
matic centres ; but if with this relief the tension is excessive, 
and the way in which the case is purchased by habit, is in itself 
a source of peril. Acts that do not call the reasoning power 
into operation and form a judgment; acts that are merely rou- 
tine or habitual, are dangerous. It is critical for man's brain 
to work automatically or by habit; it leads to anaemia. 

In anaemia of the nerve-centres produced by over-study, there 
is usually irritability and excitability of manner and an utter 
impossibility of concentration. When intellectual exertion, if 
monotonous, be carried on beyond a certain point, the brain 
becomes fatigued and anaemic, and the nutrition in the ganglionic 
cells of the cortex become impaired, diseased, altered from health; 
then headache becomes not an infrequent concomitant of the 
case, and indicates a still more advanced condition of an irritable 
and exhausted brain. Headache is indicative of cerebral debility, 
whichever of its two great factors be present, anaemia or con- 
gestion. A great deal of the present amount of anaemia of the 
nerve-centres is due to brain starvation, as well as over-Avork, 
worry and strain. It is simply preposterous for a nation of 
brain -workers to live on vegetables and starch. Our present 
diet is poor in phosphates. A brain-worker should eat freely 
of corn-bread, oatmeal in some form, and boiled white fish, 
which are true brain and nerve food. If no deleterious com- 
pound is introduced into them they give or afford pabulum for 
lost nervous energy; they relieve lassitude, refresh the nerves 
when tired by any drain, strengthen the failing memory and 
give renewed vigor in nerve-tire. 

Cerebral starvation is also brought about by adulteration of 
food, as the use of baking-powders, which destroy the phosphates 



232 DISEASES OF THE NERVOUS SYSTEM. 

in flour, corn, buckwheat, and the introduction of diabolical, 
disease-generating food, as pork, oleomargarine, glucose, which 
should certainly be prohibited by rigid laws. This insufficiency 
of brain elements in food tells dreadfully upon the offspring in 
the production of infantile brain anaemia, and it is doubtful 
whether it is not of more importance in whittling down the 
nervous system to the very lowest ebb than over-stimulating 
diet, tobacco, literature and other assigned causes. Under the 
absurd name of hysteria we find a large percentage of anaemia 
of nerve-centres in ladies. This is due to a variety of causes, 
such as their extreme susceptibility to impressions, to their 
indoor life, monotony or sameness, sedentary habits, which 
necessarily gives rise to a deficient aeration of blood, a devia- 
tion from a natural type, and causes a marked characteristic, 
which condition is aggravated by literature and surroundings. 
All morbid states of the body directly or indirectly tend to pro- 
duce brain anaemia. This is explained by reflex action. Mas- 
turbation is a dual cause, a direct drain and irritation superadded. 
Symptoms. — To lay down a train of symptoms is impossible; 
there might be forgetfulness, loss of memory, nervous debility, 
indifference to the world, white face, dilated pupil, nerve-tire or 
irrepressible languor, sleeplessness, irritability, heats and colds, 
burning in the hands and feet, vertigo, noises in the ears, specks 
and spots before the eyes, phosphates and chlorides in the urine, 
abnormal sensations in skin, seminal weakness and loss of power 
of the generative organs, or, in other words, no definite symp- 
toms can be laid down, depending a great deal on the so-called 
disease present, or that develops itself. Hypochondriacs, cranks, 
nervous dyspeptics, confirmed invalids of all sorts, widely scat- 
tered over the entire country, paralytics, monomaniacs, hysteri- 
cal subjects, bed-ridden, sleepless, helpless victims, the result 
of abuse and erroneous treatment, worn and wasted, a burden 
to themselves and their families; subjects who may or may not 
suffer from some local disorder, if none, the exhaustion, pros- 
tration, difficulty of progression, and general nervous disturb- 
ance incident to the anaemia will be paramount. As a general 
rule, whatever the phase in which it presents itself, there is 
wasting of the fatty and muscular tissues combined with the 
anaemia; the patient having lost all healthy appetite and power 
of digestion and assimilation, there being scarcely enough eaten 
to keep vitality alive. Patients suffering from cerebral anaemia, 
whether it be the monomaniac, hypochondriac, hysteric or dys- 
peptic type, have their sympathetic system highly excited and 
are highly emotional, constantly craving pity, sympathy, which 
they usually obtain to a degree prejudicial to their welfare, 
and monopolize it until the entire household and neighbors 
become victims to their morbid selfishness. One doctor is tried 



DISEASES OF THE NERVOUS SYSTEM. 233 

and another, one cure, water-cure or spring, and even different 
sections of the country are utilized with no good. 

Treatment. — In cerebral anaemia our usual medical treat- 
ment is almost useless, and this very fact necessitates a complete 
change of procedure, a change that involves not only great ex- 
pense but considerable inconvenience, as it involves the removal 
of the patients from the unwholesome moral atmosphere in 
which they have been living, away from sympathizing friends 
and neighbors; by a renewal of the patient's vitality by baths, 
brain food, and other nutrition, and causing its assimilation by 
positive muscular exercise; by resorting to peripheral stimu- 
lation, thus stimulating the reflex centres, causing an increased 
cutaneous circulation, and thus improving nutrition. The treat- 
ment is physiological, and up to the latest discoveries in medi- 
cine, and involves the following heads : — 

1. Seclusion and Rest. — This is absolutely indispensable to 
carry out the entire treatment in its most minute detail ; the 
entire seclusion of the patients under a competent nurse, and 
their removal from old scenes, associations, and the morbid 
atmosphere of invalid habits which encircles them. Unless the 
patient is entirely removed from the injudicious sympathy and 
constant waiting on of friends, it is impossible to obtain the 
necessary control over them which is requisite for a cure. This 
point is to be made absolute ; sever the connection between them 
even if it seems harsh and strange; no compromise on this 
point can be made, and if it is impossible to secure the removal, 
the isolation and perfect seclusion of the patient, better to have 
nothing to do with the case and its peculiar treatment, for even 
if they are isolated in a separate room in the same house under 
a competent nurse and visited by no one but the medical 
attendant, the case does not do so well as when apart. 

There should then be a perfect separation from all moral 
and physical surroundings; the change is beneficial, and aids 
immensely in the cure. Following this is rest in bed, absolute 
repose, no reading, talking, looking at pictures, no sewing or 
knitting, not even allowed to feed themselves for at least six or 
eight weeks. Under this condition of rest the whole system 
becomes regenerated, and new tissues begin to form ; it acts like 
a brain or nerve food; it restores lost energy, refreshes the 
nerves tired by worry, excitement or strain, and gives renewed 
vigor to the whole body. After this condition of absolute 
repose has existed for six or eight weeks, it may be broke or les- 
sened, and then the patient be permitted to sit up several hours 
daily, and gradually this is to be extended. The old diseased 
habits are to be discarded and a new life to be inaugurated 
while the above is being faithfully carried out; the essential 
part of the treatment is also being fulfilled in the form of — 



234 DISEASES OF THE NERVOUS SYSTEM. 

Massage. — Simultaneously with the condition of seclusion 
and rest being commenced, this, the really indispensable part 
of the treatment, should also be inaugurated : the entire surface 
of the body of the patient morning and evening to be thor- 
oughly sponged off with castile soap and water, and well dried 
by the nurse, and thus made ready for the massage. This is to 
be performed by a young, healthy, vigorous person, full of 
vital force, intelligent, and well posted in his or her work. 
Massage should be commenced the first day, half an hour in 
the morning, and same length of time in the afternoon, the 
duration of time increased daily, until two and a half hours 
are thus occupied morning and evening, making five hours 
altogether daily, and after its performance each time, one-half 
or three-quarters of an hour of electrical manipulation to 
follow. This massage is to consist in taking a leg and thigh, 
beginning at the toes, foot, leg up to groin, first rubbing from 
the extremity up; then grasping the parts between both hands, 
from foot up, moving each joint as you go along; then a careful, 
pains-taking kneading from the sole of the foot up, manipula- 
ting the joints well ; this is to be followed by beating or pat- 
ting with the fingers of both hands coming down on the part 
at the same time, and the whole to be followed by a rubbing 
with the points of the fingers, always moving the joints. After 
one limb has been well done, then the other ; then one arm, 
then the other ; the back, and latterly the abdomen, spending 
upon each a little over half an hour. If there is great sen- 
sitiveness, it is often best not to spend the entire time on one 
member at once, but to go from one to the other, going over 
each several times. The intensity of massage will depend 
altogether on the sensibility of the patient. In no cases is 
there any violence or roughness to be used ; neither is the skin 
to be irritated nor much redness induced. During this manip- 
ulation, the patient is to remain perfectly passive — not to make 
a single effort ; all to be done by the operator. This systematic 
shampooing, grasping, kneading, patting, beating and exercise 
of all the muscles and nerves of the body, extremities and 
trunk, has a magical effect. Its advantages are, the peri- 
pheral nerve stimulation carried to brain, cord and other 
centres, raising the standard of central vitality, the vital force 
or stamina of the operator is planted into the nervous system 
of the patient by reflex emanation ; all his reserve vitality 
accumulated are thus given to the devitalized. Nerve action 
in all cases is vibratile; in anaemia of brain an abnormal 
series of nerve vibrations are set up. This is at once changed 
by massage, which restores the healthy, mechanical vibrations 
to the nerve ; carrying the same state of vitality to the centres, 
it thus relieves wandering, erratic pains and neuralgia, strength- 



DISEASES OF THE NERVOUS SYSTEM. 235 

ens the nerve centres, and gives renewed vigor in all diseases 
of nervous exhaustion or debility ; it stimulates the cutaneous 
circulation, the muscles are exercised without the expenditure 
of nerve force ; the reflex stimulus carried to the medulla 
oblongata gives greatly improved vitality, and the psychologcal 
condition of the manipulator, as well as his vitality, is im- 
planted in the patient. To do it effectually, requires a well- 
educated person, of fine mind, strong will, solid determination, 
sound vigor, and of high vitality. The party who does the 
massage should have nothing else to do but walk around, eat 
well, and acquire all the vitality possible, so as to communi- 
cate it to the patient. The regular nurse, tired and wearied 
with his peculiar avocation, should never be permitted to 
perform the massage. There is to be no oleaginous body used 
by the operator, as that destroys or breaks the vivifying 
current. 

After the first application the patient will feel sore and stiff, 
but this will soon wear off in a few days. Although we incul- 
cate gentleness, still it must be efficient; this feeling of soreness 
will soon pass off, when the patient will enjoy the manipulation 
amazingly, and after it is performed will have a pleasant sense 
of exhaustion followed by refreshing sleep. 

Electricity. — This should follow the massage, and is to be 
used simply as a means of exercising the muscles. The inter- 
rupted current should be employed twice daily, from half an 
hour to three-quarters of an hour. The poles armed with wet 
sponges squeezed out of salt water, so as to carry the electricity 
away down into deep parts, are to be placed on the muscles to 
be operated on in turn, beginning at the leg and going up, 
taking each muscle in turn. The sponges with the poles should 
be placed four inches apart and moved slowly up and down the 
muscle until it contracts fully and freely. This is somewhat pain- 
ful and annoying, but it is of unquestioned utility in long-stand- 
ing cases of cerebral anaemia, especially where there is wasting or 
muscular paralysis. It is not to be used about the neck or 
head, and it should never be rubbed about indiscriminately, 
but simply applied to the muscles. 

Regimen and Diet. — These form an important and essential 
part of the cure. All this class of patients are but living skele- 
tons, skin and bone; white, anaemic, wasted, emaciated, neither 
able to sleep or walk; suffering a living death, mocked at by 
ignorant physicians who are too superficial to understand their 
case. And it is perfectly astonishing to see how the treatment 
tends to recuperate and rejuvenate them. Once the patient is 
secluded, it is well to cleanse out the bowels and begin with a 
milk diet exclusively for a few days. This should be given 
every two hours in sufficient quantities, which they are able to 



236 



DISEASES OF THE NERVOUS SYSTEM. 



consume and perfectly assimilate, usually from three to four 
ounces. After two days of the massage, the amount can be 
increased to eight or ten ounces, so that within the twenty-four 
hours from two to three quarts of milk will be consumed. There 
is no difficulty in getting rid of that quantity even if there is 
dyspeptic symptoms, for they disappear like magic, and flesh, 
strength and increased weight are visible to the eye from day 
to day. As soon as the manipulator reaches five hours of 
massage and an hour and a half electricity daily, one-half in 
the morning and the other half in the afternoon, then the diet 
is to be increased by the following additions, which are greedily 
taken, thoroughly digested and assimilated into brain, muscle 
and other tissues. The following schedule will give an imper- 
fect idea of the diet list or something near it : 

Every evening during the treatment there should be made 
beef tea, say a pound and a half of fine lean meat, chopped 
fine and water sufficient to obtain ten ounces; this should stand 
over night so as to be ready for use at five a. m., when, after 
the patient is sponged off, a portion of it should be taken with 
a soda-cracker. This meat extract should be seasoned to suit 
the taste, and parsley, if in season, added to it. 

At five a. m., beef extract with cracker, to be followed with 
two and a half hours massage and half an hour electricity; to 
be followed with a bowl of oatmeal porridge and cream. 

At nine o'clock, a. m., breakfast, consisting of toast and but- 
ter, soft boiled eggs, corn bread, broiled beef-steak and coffee. 

At eleven a. m., milk. 

At one p. m., dinner, consisting of boiled white-fish, chicken, 
mutton chop, broiled beef-steak, vegetables, fruit and cream. 

At three p. m., milk, to be followed with massage and electri- 
city for three hours ; to be followed with beef extract, fish, biscuit 
or milk. 

In other words, a system of feeding consisting of brain ele- 
ments, and that to excess. 

In this treatment, which is so successful, the massage is the 
dominant agent, and the question is, how does it work? The 
vital stimulus of the rubbing, patting, kneading, shampooing, 
is imparted to the superficial nerves. This passes along the 
nerve tubes by means of the pulp to the gray matter of the 
spinal cord, where, by the influence of the ganglion through 
which it runs, the supply of blood to the nerve cell is regulated. 
In the cell of the gray matter of the cord a vital electrical con- 
dition is established which travels along the spinal cord to the 
brain, which is toned up and receives more blood. Every 
rub, every vibratory thrill gives a myriad of tonic phenomena, 
which causes the anaemic capillaries to become filled with blood 
rich with brain elements, and a renewal of life in the weakened 



DISEASES OF THE NERVOUS SYSTEM. 237 

tissue promoted. This treatment, simple as it looks, needs the 
supervision of a medical attendant of great skill. The time 
necessary to accomplish a cure is usually about twelve weeks, 
unless in old cases of paralysis, which may require a longer 
period. 

Is this treatment reliable ? Assuredly it is. Not only reliable, 
but endorsed by the highest medical authorities, and thousands 
of hopeless cases of disease have been cured by it. It is no 
experiment. The nervous system is the controlling agency by 
which development is perfected, and the animal magnetism of 
the operator is the mysterious force that rouses it into action. 
No drug, no remedy but this can quicken the benumbed and 
paralyzed limb or faculty like the invigorating stimulus of intel- 
lectual animal magnetism. There is an affinity in all cases of 
debility to absorb or draw from the stronger around, to imbibe 
their nerve vigor and thus rouse their own dormant activities. 
The system of cure as laid down above comes right in among 
a class of diseases in which all remedies fail. For there is no 
drug or mechanical contrivance that can induce a healthy 
vibratory action of the nerves with living, thinking matter, and 
bring a new power to the deadened nerve forces but this. 

The disorders of the sympathetic or of the great sympathetic 
ganglionic system, which in the white man is so profusely 
reflected to the face, lungs, heart, spleen, liver and genito-urinary 
organs of both sexes, in which the moral nature of man, emo- 
tions, desires, affections and passions reside, or what some term 
his visceral brain or soul, have not as yet been elucidated, and 
therefore not classified. The immense amount of rich gray 
matter in the sympathetic ganglia and its connection with the 
organs of animal life, with the united process of nutrition, 
blood formation and reproduction, exercise an immense influ- 
ence on the circulation through the medium of the sympathetic, 
by which the neuric manipulations are produced, and any 
deviation from health in any of the organs of chest and abdo- 
men leads to anaemia of cord and brain, especially so if the 
complex generative system is affected. It may be called reflex 
irritation, or irritation carried along the sentient gray matter 
to the cells of the cord, which in time wears them out and the 
influence of repeated or abnormal vibrations exhaust completely 
the central cells and the non-vital condition is established, with 
the weakening and disturbance of the electrical condition of 
the cord and brain. The superiority of the gray cell of the 
sympathetic, its intrinsic sentient matter is apparent, its growth 
and development in man being coeval with his moral responsi- 
bility; and when any organ it freely covers is affected, as the 
uterus, the penis, the left kidney, spleen, mesentery, heart and 
lungs, then rapid changes do occur on the supervention of the 



238 DISEASES OF THE NERVOUS SYSTEM. 

irritation. In such cases we see the rosy hue of the cheeks 
becoming pale ; the graceful gambols of the child giving way 
to the distortions of chorea ; we hear the sad gurglings of the 
epileptic, or the fierce ravings of mania, or the moanings of 
melancholia. Once the affections of the sympathetic are classi- 
fied, we will be better able to treat the diseased manifestations 
of those organs under ganglionic control. 

PARALYSIS. 

A partial or total loss of sensibility, or of motion, or of both, 
in a part or of the entire body. It is said to be perfect when 
both motion and sensibility are affected ; imperfect when one 
or other is lost or diminished. The term local is used when a 
small part of the body is affected, as a limb or hand. It is 
termed reflex when it commences in the periphery of a nerve, 
and is reflected to its origin in the cord, and from thence 
reflected back to the muscles. There are, besides, some peculiar 
forms in which certain symptoms predominate, as wasting of 
muscles, tremor, etc. Paralysis is predisposed toby either a 
condition of congestion or anaemia of brain, spinal cord or spinal 
nerve — a devitalized condition ; and either of those two states may 
be associated with an exciting cause, as apoplexy, embolism or 
thrombosis, abscess, softening, induration, tubercular, cancer- 
ous, or syphilitic deposit, tremors disease of urinary organs, 
intestines, uterus, epilepsy, chorea, masturbation, disease of the 
spinal cord, as inflammation and its results, disease of the mem- 
branes of the cord or brain, lesions or compressions by which its 
working power or its conducting medium is impaired ; some 
blood disease, as rheumatism or gout acting on weakened 
nerve tissue, and to the direct influence of such poisons as 
lead, mercury, nitrate of silver, bismuth, etc. 

The term, or rather the condition of general paralysis can- 
not well exist without death, although we occasionally meet 
with cases in which both sensibility and motion are not wholly 
destroyed, but nearly so. 

Hemiplegia. — Paralysis of one-half of the body, extend- 
ing from the crown of the head clean down through the 
median line, involving the arm and leg, one side of face, 
tongue. It is the most common form, and usually spoken of 
as a paralytic stroke or attack. The left side is more frequently 
affected than the right side, and the arm somewhat more than 
the leg. Occasionally we meet with cases of transverse or 
crossed paralysis, due to accidental conditions — the causes 
either due to congestion or anaemia. Under the former, we must 
look carefully for apoplexy, clot, tumor, nodule of tubercle, 
cancer, etc.; under the latter for chronic inflammation, white 
softening, epilepsy, chorea, blood poisons, etc. A distinction 



DISEASES OF THE NERVOUS SYSTEM. 239 

or true line of demarcation is important as leading to correct 
treatment. Cases due to congestion are accompanied with head- 
ache and other symptoms of plethora, and are sudden in their 
seizure, whereas those due to anaemia exhibited such symptoms 
in the white face, nervous temperament, etc., and come on 
slowly and insidiously. 

Symptoms. — In both are the same ; muscles of the side of 
the face and brow affected ; paralyzed cheek drops loosely ; 
mouth is drawn to one side by non-contraction of paralyzed 
muscles; tongue usually implicated; when protruded, point 
turned to the paralyzed side, owing to the vigorous action of 
the healthy muscles ; articulation is imperfect. Third nerve 
not involved in the common form of hemiplegia, but tempo- 
rary lateral deviation of both eyes, and persistent turning of 
the head to the sound side in severe cases. As the hemiplegia 
is either due to the effects of congestion or anaemia, the patho- 
logical result usually takes place at the base of the brain of the 
right side, or on the side opposite from the one paralyzed, so 
the condition of the eye, as to contraction or dilatation of 
pupil, closed or staring open, will depend on the location of 
the difficulty. The arm is always more paralyzed than the 
leg, and recovers more slowly. Paralyzed limbs are soft, flabby ; 
in rare cases, rigid. The muscles of the chest and abdomen 
may not be affected chiefly in sensation, if at all. The mental 
faculties are less or more damaged — reason, judgment, memory, 
a tendency to shed tears. In effusion of blood from congestion, 
muscles often rigid or contracted; in anaemia, with white 
softening, the softening or degeneration descends the cord 
from want of nutrition, and the muscles waste or shrink away. 
Where muscles waste, case is hopeless. When the leg regains 
power first, the case is very hopeful ; whereas, if the arm before 
the leg, always unfavorable. 

Treatment. — In all cases, whether due to congestion or 
anaemia, the following is to be recommended : Secretions from 
liver, kidneys, bowels to be promoted ; skin to be daily bathed 
with alkaline washes ; feet to be kept warm by capsicum ; head 
cool ; sleep to be prolonged to nine or ten hours by extract of 
hyosciamus ; the efficacy of repeated blisters, say for six hours 
at a time, three times per week, or the irritating plaster con- 
stantly exciting free suppuration to both sides of the spine 
below nape of neck can never be doubted. The most satisfac- 
tory results are to be obtained from this proceeding. We need 
not ignore the fact that at least two-thirds of all cases are due 
either directly or indirectly to the syphilitic germ in the blood 
irritating a weakened patch of brain, and thus causing the 
paralysis. If satisfied that it is due to congestion, cerebral 
haemorrhage, effusion, active cupping to neck and shoulders, 



240 DISEASES OF THE NERVOUS SYSTEM. 

free action of bowels, and a persistent perseverance in altera- 
tives and tonics, with iodide of potassa ; the idea being, if pos 
sible, to procure absorption. If due to anaemia, or softening, 
then no cups nor free purgation, but a treatment highly con- 
structive, rich diet, excess of phosphates ; and to rectify the 
defective nutrition or anaemia, compound hypophosphites of 
lime, soda, iron in beef extract, ozonized glycerine, ozone- 
water. Besides, as it is generally chronic, alteratives and tonics 
should be carefully used all through, among the former com- 
pound syrup phytolacca, extract saxifraga ozonized, compound 
syrup yellow dock, and among the latter, mineral acids, quinine, 
iron. 

If the copper-colored roof of mouth, or nocturnal languor, or 
more prominent symptoms point to syphilis, call for no history, 
but treat it with iodide of potass, ozonized glycerine, comp. syr. 
Phytolacca ozonized, nitric acid in comp. tinct. cinchona, and 
the blisters to draw the germ of syphilis from its feeding ground 
at base of brain. 

The largest percentage of cases of this form of paralysis are 
syphilitic, and overlooked by the physician, either through his 
ignorance or delicacy in announcing the fact. Frictions, sham- 
pooing, palpation with olive oil or other stimulating liniments, 
and faradisation if there is no tendency to spasm or muscular 
rigidity or massage. 

Paraplegia. — Paralysis of the lower half of the body. There 
are two forms, one due to congestion, the other to anaemia or 
or want of nutrition; the former may be caused by falls, me- 
chanical violence, causing spinal meningitis, myelitis, with 
effusion of blood or lymph on the membranes or substance of 
cord, causing a thickening, tumour, tubercular, cancerous, or 
syphilitic deposit; the latter, defective nutrition, caused by mas- 
turbation, sexual excesses, disease of kidneys, uterus, and other 
parts, a condition in which, in its first stage, the reflex impressi- 
bility of the cord is increased — due to an insufficient amount 
of blood in the cord. 

Symptoms. — If not due to mechanical violence, it comes on 
slowly and insidiously, with great weakness, numbness and 
tingling of the feet and legs. These symptoms increase until 
there is a total loss of sensibility and motion in lower extremi- 
ties, paralysis of bladder and sphincter ani follow, decomposi- 
tion of urine in bladder, involuntary movements of the legs, 
often very distressing, marked deterioration of general health. 

Note special symptoms — if the congestion or pressure or nod- 
ule be on the membranes of cord, there is severe pain in limbs 
or back, especially on movement or coughing, resembling rheu- 
matism, reflex movements sometirr.es exaggerated, paralysis of 
sphincters later. 



DISEASES OF THE NERVOUS SYSTEM. 241 

In myelitis, dull pain, sensation as if there were a cord around 
the body ; paraplegia more decided ; reflex action in parts below 
segment attacked; often exaggerated; sphincters early affected. 

In the ansemic forms symptoms are less definite; worse 
on being in recumbent posture. When not due to mechanical 
irritation or reflex action, as in spinal irritation, often syphilis 
is the cause, which will be recognized by its concomitant symp- 
toms. 

Treatment, — The first point in the consideration of treat- 
ment is, is it one of congestion or anaemia? The land-marks 
must be carefully drawn as to that point. 

If there is congestion or inflammation, with increased deter- 
mination of blood in the cord, there will be symptoms of 
irritation of motor nerve fibres, as convulsions, cramps, twitch- 
ing, priapism, with indication of sensitive nerve fibres, as 
itching, crawling, pricking sensations, heat and cold feeling 
alternately, and symptoms of irritation of vaso-motor or nutri- 
tive nerve fibres, as wasting of muscles, bed sores, alkaline urine. 
There is also pain corresponding to the upper limit of conges- 
tion, tenderness on pressure, or a burning or sore feeling on the 
application of a hot sponge or pole of battery. 

In treating these cases, the quantity of blood sent to the cord 
must be diminished, and the normal integrity of the cord 
restored; so that cups, blisters, irritating plaster; better than all, 
the galvanic cautery on both sides of spine above and below 
the difficulty, followed with hot poultices or continuous appli- 
cation of irritating plasters on both sides of spine, two inches 
wide on each side, subsequently belladonna plaster, or some 
stimulating liniment. Internally, iodide and bromide of potass, 
with calabar bean; to be alternated with belladonna, ergot, 
camphor, henbane, conium, Indian hemp, to relieve distress 
and procure sleep ; as case progresses, ozonized glycerine, ozone- 
water, erythroxylon coca, Skin, liver, bowels, kidneys to be well 
stimulated, and diet to be generous to a fault, containing as 
much phosphates as possible. The nutrition of limbs must be 
maintained by olive oil inunction, friction, shampooing, at 
least twice or thrice daily, for twenty or thirty minutes. 

In the paraplegia due to anaemia or white softening, the 
point is to cause a determination of blood to the cord and its 
membranes and restore its vital integrity. Food loaded with 
phosphates, as animal diet, boiled fish, oatmeal, corn bread, and 
extract of meat with compound hypophosphite of lime are 
excellent; acupuncturator applied on both sides of the spine, 
followed by oil of mustard and capsicum dissolved in alcohol 
and chloroform, or else the irritating plaster on twelve hours, 
off twelve hours, are very efficacious in causing a determination 
of blood to the cord. Besides, quinine, iron, opium, strychnine 

28 



242 DISEASES OF THE NERVOUS SYSTEM. 

and camphor ; the latter rarely. The best position is on the hack, 
with limbs drawn up, so as to cause the blood to gravitate into 
the cord. The nutrition of limbs to be maintained by oil 
inunctions and stimulating liniments. 

Syphilitic Paraplegia. — The general treatment for syphilis 
must be inculcated. In paraplegia we have a controlling, 
remedy in heat and cold, or their representatives. For example, 
to dissolve menthol or thymol in equal parts of chloroform and 
alcohol and paint both sides of the spine; the chloroform carries 
the menthol away down deep; we have an anaesthetic effect over 
the circulation in brain, spinal cord and ganglia of the great 
sympathetic. In this way congestion can be modified ; if we add 
ammonia to the same prescription we can produce local conges- 
tion, an increased determination of blood. If the paralysis be due 
to any reflex cause, as teething, worms, irritability of urinary and 
sexual system, skin disease, they must, if possible, be removed. 

Local Paralysis. — There are many varieties of local par- 
alysis, extending from the head to the foot, and dependent on 
very varied causes — such as facial ; paralysis of the muscles of 
the eye, supplied by the third nerve; ptosis; immobility of eye- 
ball ; outward squint, double vision, dilated pupil. Of external 
rectus, supplied with sixth nerve, inward squint, &c. Paralysis 
of fingers and thumb in needle- women ; of the supinators and 
extensors of the forearm and hand in dish-washers ; hemiple- 
gia of penis often present in the sensualist. 

It is unnecessary to go over all ; the point is to ascertain 
their cause and remove it : If due to congestion, an active 
counter-irritant and antiphlogistic course ; if to anaemia, rest, 
stimulants, &c. 

Nearly all forms of local paralysis about the face are due to 
syphilitic disease at base of brain ; some due to other blood- 
poisons ; others to sameness, overwork, excess. General alter- 
atives and tonics seldom fail to benefit. 

Locomotor Ataxia. — An excessive formation of connective 
tissue, with wasting and disintegration of nerve-fibres of the 
posterior columns of the dorsal and lumbar portion of the 
spinal cord, which gives rise to a peculiar form of imperfect 
paraplegia. 

It is supposed to be caused by sexual excesses, the germs of 
syphilis, tubercle ; by the poison of gout, rheumatism, expos- 
ure to cold, damp ; falls or blows being simply exciting 
causes. 

It is almost invariably met with in males about the middle 
period of life. In well-marked cases there is atrophy and dis- 
integration of nerve-fibres of posterior roots of spinal cord, with 
formation of amyloid corpuscles, and great hypertrophy of the 
connective tissue of the cord. The lesion is not, in all cases, 



DISEASES OF THE NERVOUS SYSTEM. 243 

confined to the posterior columns of the cord. There is often 
a gray degeneration of cerebral nerves, of spinal nerves, and 
various lesions of gray structure. 

Symptoms. — The characteristic symptom is a diminution 
or total absence of the power of co-ordinating the movement of 
the lower limbs, so that the patient has difficulty in walking, 
loses his balance, and has a peculiar gait ; can move limbs, 
and has considerable power in them when lying down. It is 
totally distinct in its origin, symptoms and pathology, from 
paraplegia, in which, either sensibility or motion, one or both, 
are impaired or lost. 

It usually commences with stabbing or darting pains in the 
limbs ; squinting, double vision, or other impairment of sight ; 
occasionally partial paralysis of other cranial nerves beside 
the optic ; mode of walking peculiar, feet lifted up and thrown 
out in an irregular manner, and brought down violently ; turn- 
ing round is difficult, patient is compelled to watch his legs in 
order to guide their motions ; cannot stand with the eyes shut, 
or in the dark, and is unable to walk in that condition ; no 
tenderness on examination of spine ; a sensation as of pins and 
needles in lower extremities, with numbness, cramps, or neu- 
ralgic pains. Ultimately, loss of sensation in lower limbs ; 
partial or complete amaurosis from atrophy of the optic nerve; 
increasing debility, so that the patient can not leave his bed. 
Progress of the disease slow but persistent. Recovery is very 
rare. The intellectual faculties may remain unaffected till 
near the end. There is often deafness, and a sensation of con- 
striction or cords round the abdomen. The early eye-symptoms 
are to be accounted for by the branches of the optic nerve in 
the medulla and cord suffering the hypertrophy of the connec- 
tive tissue, with atrophy and degeneration. 

Treatment. — The general health should be attended to — 
baths, frictions, showering the whole body daily; secretions 
regulated ; appetite stimulated with tonics ; clothing woollen ; 
a very generous diet, animal food, boiled fish, raw eggs, milk, 
cream ; vegetable phosphates ; constant application of irritat- 
ing plaster to lower portion of spine ; persistent use of altera- 
tives and tonics. If due to syphilis, sulphur or ozone baths. 
The salts of compound hypophosphite of lime to be given daily 
in extract of beef. 

While the patient is diligently pursuing the above treatment 
there are a number of special remedies to be used or tried, such 
as phosphate of quinine, calabar bean, ozonized glycerine and 
water, belladonna, compound tincture cinchona and mineral 
acids — used as tonics, with the compound syrups of phytolacca, 
dock, &c, with iodide of potassa. Restlessness allayed and 
sleep procured by large doses of hyosciamus. 



244 DISEASES OF THE NERVOUS SYSTEM. 

Sclerosis of Lateral Columns of Cord, or excessive forma- 
tion of connective tissue, with wasting and degeneration of 
nerve-fibre of lateral columns ; invading also the anterior cor- 
nua of gray matter. 

The symptoms are gradual paralysis of muscles and contrac- 
tion of limbs ; no loss of sensation ; the sphincters often unaf- 
fected. Treat same as Locomotor Ataxia. 

Disseminated Sclerosis. — Patches of sclerosis in different 
parts of brain and cord. 

In this there is a general loss of power, with tremor and agi- 
tation of the muscles whenever they are called into exercise. 
Lips and tongue tremulous in speaking ; chin kept on breast 
to avoid the effort of supporting the head, which brings on 
tremor. Limbs quiet till moved, then agitated. 

Infantile Paralysis. — The essential paralysis of children, 
from its being thought to be peculiar to early life; not infre- 
quently do we find it in adults. It is, properly speaking, a 
systematic myelitis, a circumscribed, well-defined lesion of the 
cord, not involving neighboring parts. It is usually confined 
to the anterior horns of the gray matter of the cord ; hence the 
term anterior polio-myelitis has been applied to the disease, 
whether occurring in infants or adults. As it occurs in infancy, 
or to children under two years of age, who have received a 
fall, blow, or suffered from teething, worms, there is following 
a febrile excitement, one or more or all of the limbs become 
paralyzed ; the muscles of the trunk being also sometimes 
involved, and very exceptionally those supplied by the me- 
dulla oblongata. There may have been convulsions, coma or 
a transient loss of cutaneous sensibility, or temporary trouble 
with bladder or rectum ; but to a great extent the brunt of the 
disease falls upon the motor power of a limb or limbs. After 
the attack, the limbs does not generally become more par- 
alyzed ; on the contrary, after a few weeks or months there is 
a gradual clearing off of the difficulty, as regards some of the 
limbs, one or more remaining unimproved. Many of the 
affected muscles begin at once to waste, and lose all power of 
contractility (degeneration sets in) ; others again resume their 
tone and function. The paralyzed muscles are soft and flaccid. 
After a variable period, there may be a gradual return of 
power, and some recover, while others rarely do so. In the 
end, in the affected muscles, atrophic changes are well marked, 
which may be so wasted as to leave the limb in a skeleton-like 
condition, or fatty substitution may mask the real loss of mus- 
cular substance, and give a false air of plumpness to the limb. 
The development of bone is also arrested, so that in several 
years after it may be shorter and thinner than its fellow. There 
is diminution of the calibre of blood-vessels, leading to com- 



DISEASES OF THE NERVOUS SYSTEM. 245 

parative coldness and blneness of the limb, which often shows a 
strong liability to chilblains. The tonicity of unaffected mus- 
cles would seem to increase and overpower those whose func- 
tion is destroyed, giving rise to deformities which no efforts 
can reduce. 

In treating cases of this kind, the cause, if possible, should 
be removed, the mouth examined, and gums lanced, if neces- 
sary; confine the patient to bed for many months. Bromide 
of potass and ergot should be given early ; muscles tested 
electrically for the first few weeks ; any electrical treatment 
better to be avoided ; discourage all attempts of voluntary move- 
ments of the damaged muscles or limbs, as it tends to excite 
action in their antagonistic muscles, and thereby increase the 
deformity ; baths, oil inunctions, shampooing twice daily; stim- 
ulating linaments to spine ; secretions attended to, and the gen- 
eral health built up ; a general alterative and tonic treatment 
persevered in ; diet rich in fibrin and phosphates. 

Hysterical and Rheumatic Paralysis. — In hysterical par- 
alysis, we must look for an hyperemia or excitation or exalta- 
tion of sensual and motor nerves and their centres ; very com- 
mon in young men or women addicted to masturbation, or suf- 
fering from worms or other irritation of genito-urinary organs. 
It may in the same class of patients be excited by fright or 
other emotional condition; it may appear as hemiplegia, para- 
plegia, local, as aphonia, loss of voice, or some other part. The 
general symptoms of exaltation of nerve tissue in an hysterical 
subject will guide us to a correct diagnosis. It should be 
treated by removal of cause, as irritation of generative organs, 
disease, etc. May be cured by alteratives and tonics, and 
improvement of general health with shower bath, ice to spine. 

Rheumatic paralysis is mostly confined to the muscles of 
lower extremities, forearm and arm, as the deltoid and tra- 
pezius, rendering it difficult to move the arm. Usual anti-rheu- 
matic treatment; iodide of potass, colchicum, salicylate, soda, 
quinine. 

Progressive Muscular Atrophy. — Wasting paralysis, with 
granular and fatty degeneration, and extreme wasting of mus- 
cular fibre, owing to defective nerve nutrition or supply. 
Patches of granular degeneration are found in the gray matter 
of spinal cord, whence nerves pass off to the affected muscles. 
There is also to be found starch globules or amyloid nodules 
around the central canal of cord. Nerve-cells shrunken and 
atrophied. It is very generally conceded that these organic 
changes in the cord take place some time before the muscles 
become affected. 

Causes. — It seems to depend upon a constitutional defect, 
often hereditary, blended with tuberculse, syphilis, caries, and 



246 DISEASES OF THE NERVOUS SYSTEM. 

disease of bones, phthisis and other chronic diseases, in which 
a substance analogous to vegetable starch is found in round, 
oval or concentric layers usurping the place of nerve fibre. It is 
common among children, adults, and even the aged ; males suffer 
more than females. Exposure to wet, cold, damp, hard work 
may act as an exciting cause. It is often a sequel of fevers, 
falls, blows, sun-stroke. 

Symptoms. — Its characteristic symptom is wasting, degen- 
eration, with loss of volume and power of voluntary muscles, 
without diminution of intelligence or sensibility. It may 
affect the upper or lower portion of the body, or the entire 
muscular system, or special muscles ; whatever muscles become 
affected waste away and disappear, leaving nothing but skin 
and bone ; with wasting comes weakness ; tremors or con- 
vulsive quiverings of some of the coverings of the wasted mus- 
cles produced by irritation of skin, and more rarely neuralgic 
pains ; extreme sensitiveness to cold ; intellectual powers not 
disturbed ; general health may even be good ; when muscular 
atrophy is complete, only skin and bone left ; patient has to be 
lifted and fed like a child. But after an indefinite period, power 
of articulation and deglutition become lost, and asphyxia may 
cause death, or some accidental condition may bring it about. 

The duration of the disease may be from months to years. 
Complete recovery is rare, though the disease can often be 
retarded. 

Treatment. — General alteratives and tonics ; diet very gen- 
erous ; daily bathing ; sulphur or ozone ; if syphilis is thought 
to be the cause, baths, followed by inunctions of olive oil, with 
friction, shampooing; hypophosphite of soda or lime; glycerite 
of ozone. 

Pseudo-hypertrophic Paralysis. — Essentially a disease of 
early life, mostly affecting male children. The child becomes 
weak on its legs, constantly falling, and getting up with diffi- 
culty ; walk slow, clumsy, waddling , great aching in loins ; 
calves of legs and buttocks of immense size, which is due to an 
immense growth of connective tissue, the muscles being entirely 
wasted ; no treatment of any use ; death after a long number 
of years. 

Diphtheric Paralysis. — After partial recovery from attacks 
of disease-germs, as in diphtheria and typhoid fever. The 
oidium albicans of diphtheria not only affects the blood, but 
often produces grave changes in the nerves ; in some cases 
causes irreparable damage. It may assume the form of hemi- 
plegia, paraplegia, although more general^ it is local. Loss 
of sensibility and motion is common. It is invariably asso- 
ciated with anaemia, and may last quite a number of months. 
Patients generally make a good recovery. 



DISEASES OF THE NERVOUS SYSTEM. 247 

It requires a very constructive treatment, as regards diet 
and drugs — nerve tonics, local stimulants, friction, shampooing, 
change of air, sea bathing. 

Mercurial Paralysis. — The inhalation or absorption of mer- 
cury produces a characteristic form of palsy, chiefly affecting 
the nerves that supply the voluntary muscles, causing a con- 
vulsive agitation, which is very much increased when volition 
is brought to bear upon them. 

It is much more common than is generally supposed. The 
finer soluble preparations used by sectarian physicians — a set 
of knaves, who administer mercury because it is tasteless, acts 
very deleteriously on their dupes. The amalgam used by den 
tists is made up of pure mercury, and the coloring matter of 
much of their vulcanites is of the same metal. Besides, the 
workmen are exposed to its fumes in various mechanical and 
scientific pursuits, as looking-glass makers, button-gilders, glass 
and metal-platers, barometer-makers, etc. Chemists are much 
exposed, and should observe the greatest precautions to avoid 
the inhalation or absorption of this deadly poison. 

The symptoms of mercurial poison of nerve tissue are variable, 
but embrace impairment of articulation and mastication, and 
often the power of locomotion. Delirium and acute mania are 
often piesent ; the use of the hands are almost entirely lost; often 
epilepsy ; great weakness and restlessness ; skin acquires a dirty 
brown hue; soreness of gums; teeth turn black and decay; 
other bones become affected with inflammation, caries or 
necrosis, or lumps form on them ; anaemia. 

Treatment. — Removal of cause. Very liberal and nutritious 
diet, attention to bladder and bowels ; baths, sulphur or else 
sulphuret of potassium with electricity; chlorate of potassa as 
a mouth-wash, of which some may be swallowed; due attention 
to other symptoms. From the moment of its recognition till 
weeks after recovery, iodide of potassa in doses of from five to 
fifteen grains thrice daily in sweetened water. The iodide unites 
with the mercury in the body, forms an insoluble compound, 
which is readily eliminated by the kidneys and to some extent 
by bowels and skin. In some cases it is advantageous to com- 
bine it with bicarbonate of potassa or carbonate of ammonia. 
No drug is of any real value but the iodide. 

Lead Paralysis. — Lead exerts a very deleterious influence 
on the nervous system and blood. Its poisonous effects seem 
to manifest themselves on the finer nerves that supply the mus- 
cles of the forearm and duodenum. It usually finds access to 
the body by inhalation, in water, food and through the skin. 
Lead poisoning is more common than is generally supposed. 
The inner surface of the lead water-pipes of cities, oxidizes and 
finds its way into the water and is drunk. Lead enters into 



248 DISEASES OF THE NERVOUS SYSTEM. 

the composition of culinary articles, as glazed earthenware. 
Acetate of lead is freely introduced in claret wine, and sailors 
who drink water from casks that once contained claret are often 
affected with lead poisoning. Operatives in lead mines, workers 
in lead, either as a metal, medicinal or chemical agent, paint, 
all suffer to a great or less degree. Those engaged in preparing 
the finer preparations, as carbonate, acetate, oxide, etc., are 
more common victims than plumbers, painters, oil-cloth work- 
men, paint-grinders. 

Symptoms. — General indications of debility, with paralysis 
of tiie nerves that supply the muscles of the forearm and hand; 
extensor muscles of hand and fingers get paralyzed and hang 
down by their own weight when arm is stretched out, — called 
wrist-drop. Frequent attacks of lead colic. Taste and breath 
have a lead odor. Formation of a blue line on the edge of the 
gums just where they join the teeth is nearly always present 
and is typical of lead poisoning. It rarely affects lower extremi- 
ties. If the patient's vital forces are impaired by drink and 
excesses, or frequent attacks of gout or rheumatism, it may 
cause death. 

Treatment. — Same as for Mercury, Iodide has the same 
action on lead as on mercury. All operatives in lead should 
be strictly temperate; use no alcoholic drinks, endeavor to main- 
tain a high standard of health, promote the function of skin by 
daily alkaline bathing, and should drink sulphuric acid lemon- 
ade daily. 

Paralysis Agitans. — Shaking palsy, characterized by an 
involuntary tremulous agitation of muscles, which is indepen- 
dent of exertion and goes on while the muscle is at rest. Usu- 
ally makes its appearance from fifty-five to sixty-five years of 
age; generally met with in men. 

Its cause and pathology are unknown. It commences in the 
hands, chin or knees, and gradually extends over the entire 
body. Fingers and thumb generally in contact, as if taking 
a pinch of snuff. Associated with great nervous debility, rest- 
lessness and sense of heat; muscular power greatly diminished; 
intellect and senses damaged. Disease progresses slowly, usually 
taking about seven years before general paralysis and white 
softening set in. When well advanced, agitation or tremor may 
be so bad as to prevent sleep ; deglutition and mastication per- 
formed with difficulty; a propensity to bend the head forward 
and to pass from a walking to a running gait; inclination of 
the body forwards, with bending of chin on sternum; slobbering, 
involuntary escape of urine and faeces; delirium, fatal coma. 

Treatment. — Cases are so utterly hopeless that few remedies 
are of much avail. Nevertheless, a general alterative and tonic 
course should be inculcated, with baths, friction, shampooing, 



DISEASES OF THE NERVOUS SYSTEM. 249 

local stimulation to spine. Diet to be very generous, containing 
an excess of vegetable phosphates. 

NEURALGIA. 

Violent paroxysmal pain in the trunk or branch of a nerve. 
The paroxysms may be at stated periods with regular intervals 
between. It may attack any nerve in the entire body, but the 
subcutaneous nerves of the head, trunk and extremities suffer 
most severely. 

Neuralgia may be said to be the cry of a nerve for richer 
and purer blood, being essentially a condition of defective nutri- 
tion, — debility being a prime factor in the case; over-work, 
struggle, worry, badly fed or defective nutrition. 

Varieties. — When the pain affects branches of fifth pair of 
nerves it is called tic douleureux; certain nerves about the head, 
hemicrania; sciatic nerve, sciatica; the cardiac nerves, angina 
pectoris; nerves of the stomach, gastrodynia; the brachial plexus, 
brachialgia; intercostal and neuralgia of uterus, ovaries, kidneys, 
bladder, testis, etc. 

Causes of neuralgia are to be found in anaemia, rheumatism, 
gout, malaria, syphilitic taint, tubercle, over-fatigue, exposure to 
wet or cold, disease of teeth, gums, dyspepsia, disease of kidneys, 
disease of bones, organic disease of brain, mercury, lead, etc. 

Tic Douleureux — May affect either of the three branches 
of fifth pair of nerves. When pain depends upon morbid con- 
dition of first or ophthalmic branch, the supra-orbital nerve is 
most frequently attacked ; suffering referred chiefly to forehead. 
Suppose the second or superior maxillary branch is the seat of 
the complaint, infra-orbital nerve commonly affected. Symp- 
toms consist of excruciating pain shooting over cheek, lower 
eyelid, alvea of nose and upper lip. Neuralgia of the third or 
inferior maxillary branch is generally confined to inferior den- 
tal nerve; pain is referred to lower lip, chin, teeth and side of 
tongue. 

Hemicrania. — Headache affecting one side of brow and fore- 
head, often accompanied with sickness; often periodical. 

In the treatment of neuralgia we of course must remove the 
cause, but we can never afford to let the patient suffer until 
that is effected, because that is usually a tedious affair in nerve 
diseases; so the first point that we shall enumerate is the alle- 
viation of pain. 

Oroton Chloral Hydrate: This contains two more atoms of 
hydrogen than the chloral, and is, properly speaking, but}d 
chloral, which has the property of diminishing sensibility before 
producing narcosis. It gives instant relief in facial neuralgia 
in doses of fifteen grains, repeated, if necessary, after meals or 
largely diluted with water. The syrup of croton chloral is an 



250 DISEASES OF THE NERVOUS SYSTEM. 

elegant and efficacious preparation. It gives immediate relief, 
but to effect a radical cure the cause must be removed. To 
combine the croton chloral with quinine we have still a more 
effective remedy. 

Citrate of Caffeine is a valuable drug in facial neuralgia, the 
dose to be such as will give relief of pain. It operates better 
than guarana, — not so rapid and effectual as the croton chloral. 

Bromo-Hydric Acid, with or without quinine, of which it is 
a solvent, operates very beneficially, if the neuralgia is due to 
reflex causes, in doses of from half a drachm upwards. 

Tincture of Green Root Gelseminum, being non-poisonous only 
in very large doses, is best adapted to malarial cases, in doses of 
half a drachm upwards. 

Salicylate of Quinine, in rheumatic and gouty cases, is so speedy 
in its action that it is unnecessary to precede it with any of 
the above remedies, for in six-grain doses it is usually effica- 
cious within a few minutes. 

While pursuing this course of treatment in relieving pain, 
the cause must, if possible, be ascertained and removed. In 
looking over the list of causes, we must scan them carefully as 
to an«3mia, mercury, malaria, gout, rheumatism, syphilis; and 
to reflex causes, as teething, worms, liver, kidney, or other 
forms of chronic disease. The treatment should in all cases 
be adapted to each, and if no cause can be ascertained, the 
patient should be put upon an alterative and tonic course — all 
through relieving the intolerable pains. In these cases the 
condition of stomach, bowels, skin, kidneys, should be seen to. 

Local remedies for the relief of pain are of little utility, but 
if used should, in all cases, be combined with chloroform, to 
carry the remedy down to deep-seated parts. Aconite and bella- 
donna are especially valuable in neuralgia of facial nerves; 
cinchona, iodine and gelseminum, if of a malarial type; coffee, 
if due to nervous, anaemia; phosphate of quinine, if due to gout; 
and general treatment as to cause. Improvement of the general 
health in all cases. Diet very nourishing, raw eggs, animal 
food, milk. Clothing warm, flannel next skin. Warm tepid or 
cold salt-water baths. Friction to skin; change. Indeed, every- 
thing to improve the nervous system, and give the patient richer 
and purer blood, pure air night and day, great cleanliness, and 
avoidance of all causes. 

Sciatica. — Acute pain following the course of the great sciatic 
nerve, extending from the sciatic notch down the posterior 
surface of thigh to the popliteal space, and often along nerves 
of leg to foot. 

The causes are, a depression of the sheath of the nerve by 
cold, damp, or like conditions, irritated by blood circulating 
through it charged with the lactic or butyric acid of rheuma- 



DISEASES OF THE NERVOUS SYSTEM. 251 

tism, the soda of gout, or the germ of syphilis. Sciatica, properly 
speaking, is not an affection of the nerve, but its sheath, which, 
under the irritation, becomes thickened, and contracted, com- 
pressing the nerve, and thus causing the excruciating pain in 
movement, or numbness in the leg by compression. Sciatica, 
then, is not, at least at first, neuralgia of the nerve, but inflam- 
mation and thickening of its sheath, and this thickening produces 
a mechanical condition which presses the nerve, and thus gives 
rise to the neuralgia. 

In the treatment of sciatica, the same ideas are to guide us as 
in the other forms of neuralgia — pain must be relieved ; if the 
remedies laid down fail, then hypodermic injections of sulphate 
of morphia, repeated at intervals, or else anaesthesia of the 
nerve, produced by the proper remedies; as the application of 
menthol, in solution in alcohol. Active cupping once a week, 
or the acupuncturator thrice weekly, or the irritating plaster, 
worn continuously along the course of the nerve, are all excellent 
in promoting an absorption of lymph. The irritating plaster is 
the best application. Then, attention to the general health, and 
secretions. Case treated according to cause — gout, rheumatism, 
or syphilis; and whichever blood-taint lies at the root of the 
difficulty, a persistent use of iodide potass in the compound 
syrup phytolacca, or the glycerite of ozone; iodine, acids in 
the absorption of the effused lymph; Iodoform occasionally; 
but let the main drug be the iodide of potass, in doses of not 
less than five grains, thrice daily. 

STAMMERING. 

Impediments of speech (stuttering) in nearly all cases is a 
nervous affection; having as its origin a want of equilibrium of 
the gray and white matter of the cervical portion of the cord, 
resembling chorea. The vocal apparatus is usually perfect. It 
may be congental, but more likely to be the result of some 
shock in a fright, blow, or reflex condition, or follow some fever, 
worms, masturbation. 

The treatment consists in the removal of the cause; improv- 
ing the general health by bathing, clothing, frictions to the 
cervical portion of the spine, thus raising its standard of 
vitality. 

Same remedies as for Chorea. Make the child speak slowly 
and distinctly. Let him fill his chest well before he articulates 
a word, and then enunciate one word after another. If unable 
to do that, let him beat time for every word he utters in talking 
or reading. A persistent course of measuring the words until 
the stammerer can read and talk straightforward for an hour, 
daily, will soon overcome the habit. Let the diet be brain-food, 
boiled fish, oatmeal porridge and massage. 



252 DISEASES OF THE NERVOUS SYSTEM. 

NEURITIS. 

Inflammation of a nerve is a rare disease. Nerve tissue being, 
intrinsically the most valuable texture in the body, the most 
highly organized, is the most difficult to depress. Even a bruise 
or wound is not sufficient; but it may arise spontaneously in 
gouty, rheumatic, mercurial and other depressed subjects. 

Symptoms. — Rigors, fever, restlessness, severe and continuous 
pain shooting along nerve and its branches, muscles waste. 

Treatment. — Arterial sedatives; free secretions; alteratives 
and tonics as to cause. The best local application, is the aconite, 
belladonna, and chloroform liniment. Rest. 

NEUROMA 

Is a solid or systic tumor connected with a nerve. Solid 
growths are fibrous in their character, consisting of dense plastic 
matter, implicating neurilemma and nerve fibres. Occasion- 
ally nerve fiibres merely spread over tumor without being 
involved in its texture. A nerve, when divided, if its two 
ends are placed in apposition, will unite like bone, and sensi- 
bility and motion be restored. If not placed in apposition, 
their extremities will become bulbous, or may aid in the for- 
mation of these growths ; so they are common after lacerations, 
tears, wounds, injuries, amputations. There may be one or 
several, and vary in size from a grain of barley to a melon. 

Sy mptoms.-'-These growths are found in the course a of nerve; 
grow slowly but steadily ; of an oval or oblong form ; long axis 
in the course of the nerve; darting, lancinating pains in 
paroxysms. 

Treatment. — Excision is the only hope of cure ; tumor to 
be carefully dissected out, and, if possible, the ends of the 
divided nerve to be brought into apposition, and an effort 
at least made to keep up continuity, so that the function of the 
nerve be, if possible, restored. 

HABITS. 

Man, with his instinctive and moral nature, is easily mod- 
ified by habits ; more especially by the love of stimulants, which 
is an inherent element of both barbarous and civilized races, 
as is seen in the betel chewing and opium smoking of semi- 
barbarous races. 

Tea and Coffee Habit. — The former, essentially enervating 
and waste-producing ; the latter, highly constructive, bracing, 
giving civilized man remarkable powers of endurance ; often 
becoming an inveterate habit, but never very pernicious. 

The Alcohol Habit. — In no country in the world does the 
use of whisky and malt liquors produce such direful results as 
they do in our climate. Our dry, clear atmosphere is highly 



DISEASES OF THE NERVOUS SYSTEM. Zbo 

oxygenized, vivifying and stimulating, causing great activity of 
muscular movement and cerebral thought ; add to it another 
fuel, it actually burns up the tissues. The use of alcohol in 
small quantities produces chronic inflammation of the stomach, 
arrests normal metamorphosis ; that is, checks elimination by 
liver, kidneys and other excretory glands, and tends to the 
production of fatty degeneration in muscles and glands ; besides, 
it coagulates, indurates, atrophies the cineritious or cell-pro- 
ducing structure of the brain ; at the same time, it paralyzes the 
motor elements. Its use in large quantities so coagulates and 
shrivels up the abode of Deity in man, that every vital function 
is destroyed, or at least impaired. As an illustration : should 
the drunkard impress his damaged spermatozoa upon the 
living healthy ovum ; that is, if there be progeny, it will be 
tubercular, of a brain type, weak-minded, imbecile, idiotic, or 
the victim of nervous disease. Habitual inebriation is not 
even necessary to produce this result. One dose of this poison 
will prevent the brain elements from developing in the embryo, 
foetus, child or adult. Brain-growth is retarded, and incapable 
of habitation by the soul.; idiocy of a congenital type is im- 
pressed ; judgment, reason, memory is defective. 

The Tobacco Habit. — This is one of great importance to 
our people, to whom from mere babes to a short old age, it is of 
very general use. It relaxes and enfeebles the muscular system, 
especially involuntary muscular fibres, like the heart and 
stomach ; it exhausts the base of the brain ; gives rise to 
aphonia or paralysis of the cerebral faculty of speech. Take 
alcohol and tobacco in their joint action, they dwarf and 
atrophy the brain, cause tubercular in the user and his off- 
spring ; they fret, whittle down the over-stimulated American ; 
and, under these two habits, it is difficult to say what new 
forms of degradation and disease may not be produced. 

The general method of use is by smoking, chewing, snuffing; 
ladies are often addicted to it in the form of eating snuff. We 
are unable to account for so many ladies using it, as it is ruin- 
ous to their nature, hostile to their happiness. How disease- 
creating, nauseous, disgusting tobacco ever became a habit to 
our ladies is an enigma to be solved : its use constantly indi- 
cates degeneracy and corruption. The use of tobacco in all 
cases is inimical to health. Snuff-eating is confined to ladies, 
and they generally begin by using snuff as a tooth powder ; 
the habit gains, and the nervous system craves the stimulant; 
but it soon destroys the rosy hue of health and subverts and 
ruins digestion ; following that, the complexion becomes pale, 
sickly, yellow ; the cheeks lank, faded and hollow ; eyes lose 
their brilliancy, and become jaundiced, sunken, hollow, beam- 
less. It destroys the vital energies, gives rise to languor, 



254 DISEASES OF THE NERVOUS SYSTEM. 

debility, tremors, disturbed sleep, and gives the eater the sepul- 
chral shade of death. In the form of minute sub-division of 
snuff, its action is more destructive than by smoking or chew- 
ing, and how young blooming girls can bear its use is most 
unaccountable. 

The Opium Habit. — This is generally created by the physi- 
cian prescribing opium or morphia for the relief of pain ; but 
ladies have found out that it gives unusual brilliancy to the 
eyes, and have got in the way of using it too extensively. Its 
use at first is not incompatible with great intellectual efforts 
and brilliant thought, but by and by, when it makes its dread- 
ful ravages into the brain, muscle and gland, it is, without a 
doubt, the most persistent, irresistible and destructive of all 
habits. It over-stimulates, and thus exhausts, giving rise to 
the most feeble form of languor and despair ; it atrophies the 
brain, so that the consumer is dull and stupid; it causes 
sterility, drying up the very fountains of life, and causing a 
human wreck often fearful to behold. 

The Chloral Habit. — 'This is another very destructive cere- 
bral stimulant, exhausting more especially the ophthalmic tract 
and causing impaired vision. Much used. 

Arsenic, belladonna and other cerebral stimulants are not 
much used in this country. 

Treatment. — Moral and physical restraint, free secretions, 
baths and massage daily, with a most generous diet and the 
internal use of erythroxylon coca. 

Coca, of all known remedies, is specially adapted to take the 
place of alcohol, tobacco, opium, chloral. The drug habit is to 
be at once discarded, and the coca, in sufficient doses and at 
proper intervals, substituted. The patient is better satisfied 
with it than his favorite stimulant. If he continues its use it 
will do no harm, because on it his appetite improves, his sleep 
is prolonged, his strength physically and mentally increases, 
and he is the being of a new existence, free from the slavish 
action of the habit and capable of wonderful powers of endur- 
ance and fatigue. Coca erythroxylon is an inestimable gift to 
civilized man. Its wonderful action on the nervous system in 
causing its recuperation under the most adverse conditions; its 
stimulating power in perfectly supplanting the most inveterate 
habit, the person feeling better with it and having the power 
of discarding it at any time after six or eight weeks use. It is 
important to get a good article. 

The property of coca is not found in any other drug, viz: in 
removing entirely the desire or craving for any other drug. It 
causes an effect which is difficult of explanation, but it is the 
remedy in opium, alcohol and chloral habit and dipsomania. 
It is a safe, reliable nerve tonic, acting rapidly as a diffusible 



DISEASES OF THE NERVOUS SYSTEM. 255 

stimulant, leaving no unpleasant effects. It acts promptly upon 
the nerve centres, causing mental quietude and satisfaction, 
with easy respiration and excellent digestion ; acting upon the 
cord, relieving anaemia of that structure. It has a most won- 
derful effect in relieving that undefinable sensation of languor, 
weariness and mental unsteadiness. It is very exhilarating, 
which is followed by ease and comfort, relieving all mental 
misery and distress. 

Arsenic Habit. — This is not so common in our country as 
the others, still, isolated cases are met with now and again. It 
is generally found in ladies, first inaugurated by ignorant doc- 
tors prescribing arsenic for some roughness of the skin. Its use 
gradually wears on the patient, stimulating both brain and heart 
until the habit is acquired, when the patient can tolerate large 
doses of the drug in solution as well as in a crude state. Still, 
the lady, in order to procure the smooth, enameled white skin, 
will persevere, until some day an over-dose is reached, which 
will terminate the case, and some one else suffer from her reck- 
less indiscretion. 

No special antidote known. Self-denial, general alteratives 
and tonics. 

Although those and other habits are thus acquired, it must 
ever be borne in mind that in all cases the working faculty of 
the brain is thrown out of gear. Brain and nerve tissue are of 
the highest possible organization ; they play in the organism 
the part of primary activity. They are the centres of all energy, 
they generate all force. They do not live for themselves but 
for the whole body, and when a habit is created, their nutrition 
is impaired. We see this well illustrated in the dwarfing and 
whittling-down process when any of those habits are acquired 
by children or young persons in arresting their growing brain. 
It is positively certain that those habits never strengthen the 
brain, but it is too true that they impair its activity, retard its 
progressive tendency. That higher organism, the brain of man, 
certainly requires a better stimulus than what can be supplied 
with alcohol, tobacco or opium. None of these elements impart 
nutrition nor growth. No; they are fatal to the growing brain 
of man; they cripple its organization; they do irreparable, 
structural mischief, the effects of which are permanent. A well- 
fed and properly exercised brain free from those habits, works 
without tension or friction of any kind. The knit brow, strain- 
ing eyes and fixed attention of the tobacco or opium slave, are 
not a token of power but of weakness. When the brain is not 
crippled by those debasing, deleterious habits, its intellectual 
faculties work easily, without tension or jar. 



256 DISEASES OF THE ORGANS OF CIRCULATION. 

DISEASES OF 

THE ORGANS OF CIRCULATION 

HEART AND BLOOD-VESSELS. 



ATROPHY OF THE HEART. 

A condition in which the whole heart diminishes in size, 
wastes and dwindles in all its parts, and is found diminished 
in weight from nine to five ounces ; in other cases the muscular 
walls suffer. 

Causes. — As the heart is an involuntary muscle, it is liable 
to be affected by any mental strain or worry; that is, its nutri- 
tion is impaired. Tobacco exercises a very deleterious effect 
on it in depriving it of, or impairing its vital tonicity. Sexual 
excess tells badly on the heart. All forms of cerebral exhaus- 
tion, poisons, like alcohol, and deleterious drugs, all anaemic 
states of blood, tend either directly or indirectly to cause atrophy. 
Depression of the great sympathetic whose branches cover the 
anterior portion of the heart, is also a common cause. 

Symptoms. — The general symptoms are those of debility 
and anaemia, vertigo, specks or spots before the eyes, noises in 
ears, paleness of the surface, lips, tongue, coldness of skin, tem- 
perature low, pulse fifty to sixty, respiration twelve. On per- 
cussion over region of heart, instead of the area of dullness 
being four square inches, or the size of the closed fist of patient, 
it is very greatly diminished; on putting ear to chest, systolic 
and diastolic sounds scarcely audible. 

Treatment. — General attention to bowels, skin, kidneys; 
flannel clothing; a diet rich in blood elements, animal food, 
milk, eggs, etc. Whisky, tea, coffee, sexual excess, tobacco, study, 
or worriment of any kind strictly forbidden. Stimulating appli- 
cations over region of heart, as mustard, capsicum or warming 
plasters, better still, irritating plasters. Gentle exercise in open 
air, and then try quinine and aromatic sulphuric acid, com- 
pound tincture of myrrh and quinine. General constructive 
course of treatment with gentle open-air exercise. 



DISEASES OF THE ORGANS OP CIRCULATION. 257 

FATTY DEGENERATION— ATROPHY. 

This may be a sequel of simple atrophy, for in the degenera- 
tion of muscle there is an inherent tendency in it, when its 
fibres waste, become pale and inelastic, for its proper struc- 
ture to be usurped by fatty nodules. Some suppose that fatty 
degeneration may take place without atrophy. When it occurs, 
muscular fibre is either usurped by or infiltrated with fatty 
granules, with or without any fatty disease of liver or kidneys. 
Valvular disease may or may not exist; when it does, aortic 
more generally affected than mitral valves. Same symptoms 
as in atrophy, with the exception that there is more giddiness, 
nervous exhaustion, loss of tone; heart's sounds not only weak 
but irregular; often dropsy and pulmonary apoplexy and attacks 
of neuralgia of the heart. Common among those advanced in 
life ; apt to cause death by rupture of heart after any mental 
or physical excitement. 

Treatment same as in Atrophy. 

HYPERTROPHY OF HEART. 

Enlargement of the heart is much more common than atrophy. 
The weight of an adult male heart is about nine and a half, and 
the female eight and a half ounces, but in enlargement it often 
weighs several pounds. Hypertrophy may take place in various 
ways. It may be general, that is, its walls increased in size or 
thickness without any change in its cavity, — this is called sim- 
ple hypertrophy; the walls may be thickened and the cavity 
enlarged, — called eccentric hypertrophy, or enlargement with dila- 
tation ; or the increase of thickness of its walls may be accom- 
panied with diminution of cavity, — concentric hypertrophy. 
In cases of valvular disease and other forms of obstruction, 
hypertrophy is of utility in overcoming the impediment to a 
free flow of blood. Hypertrophy of left ventricle is usually 
due to aortic valvular disease, or to Bright's disease, in which 
there is resistance to the passage of the blood through the arteries 
and capillaries. Hypertrophy with dilatation of right ventricle 
generally due to disease in the mitral valve, causing obstruction 
to the pulmonary circulation, or to some chronic disease of 
the lungs. 

Causes. — Enlargement of the heart may be predisposed to 
by the use of tobacco, tea, alcoholic stimulants, great mental 
strain, worry, disease of brain, blood, etc., although the common 
exciting causes are over-stimulation, excitement, violent mus- 
cular exercise, as running, jumping, rowing, hoisting, lifting ; 
excess, use of malt liquors, sexual excitement. 

Symptoms. — There is usually vertigo, muscse volitantes, tin- 
nitus aurium, redness of face or plethora; heat, respiration and 
pulse are up. The sounds of the heart are not only frequent 

29 



258 DISEASES OF THE ORGANS OF CIRCULATION. 

but loud, audible at a distance; there is a fullness or bulging, 
often a wearing away of the ribs ; instead of the area of dull- 
ness on percussion being four square inches, it is increased to 
more than double; there is also numbness in left hand extend- 
ing up the arm, caused by a distension or stretching of the recur- 
rent branches of the subclavian nerve over the heart reflected 
to the brachial plexus, thence to the hand. There may be 
bleeding at the nose, cough, difficulty of breathing from enlarged 
heart pressing on lungs ; often palpitations ; difficulty in walking 
quickly; uneasiness, and sense of fullness and pain about cardiac 
region. 

Treatment. — An avoidance of all mental and physical excite- 
ment; prohibit tobacco, tea, coffee, whisky, ale, sexual congress. 
Diet nutritious, but not much animal food unless there is 
debility; clothing warm, abundance of fresh air. Keep the 
circulation tranquil with digitalis, which will slow the heart, 
contract its fibres, diminish its size. It may be necessary to 
keep the patient on digitalis for one or two years, and as it is a 
permanent tonic and astringent the longer it is given, instead 
of increasing, it is rather necessary to diminish the dose. Its 
proper management is our main reliance in hypertrophy. Give 
slowly, guardedly bring the pulse to seventy -five and keep it 
there. Aconite and cactus grand, may once in a while be of 
utility; iodide and bromide in vegetable alteratives are of utility. 
If there is debility, tonics; secretions kept active. Belladonna 
plaster over region of heart. 

FATTY DEGENERATION OF THE HEART. 

In atrophy and hypertrophy of heart, when the minimum 
or maximum is reached, there is great tendency for the usurpa- 
tion of muscular structure by fat. Indeed, this is the natural 
tendency of muscular degeneration, and it is to be looked for 
if the case does not admit of cure. Fatty heart is to be found 
also in a condition of general obesity, and when it occurs here 
its chief features are, those of an enlarged heart impeded in its 
functions. Pulse quickened while its force is diminished. 

There are many mysterious notions about the fatty heart which 
adds to the general dread of it in and out of the profession. We 
cannot say positively during life that a heart is fat. We have 
no signs during life that can point out the dead-leaf color of 
the ventricles, or the rows of beads of fat within, or the loss of 
striation with fat granules in the fibres, commencing in fatty 
necrosis. But a strong suspicion is warranted if there be fatty 
degeneration elsewhere, such as an arcus senilis, or pain across 
the sternum; paroxysms of severe pain in the heart; sighs fre- 
quently; is easily put out of breath ; skin having a yellow, greasy 
look; subject to syncope, or to seizures in which the respiration 



DISEASES OF THE ORGANS OF CIRCULATION. 259 

seems to stop ; vertigo and congestion of brain. Still, there are 
a group of symptoms that point out a want of vigor in the 
heart; of arterial anaemia, in cold extremities and a defective 
pulse; of easily excited difficulty of breathing; of syncope and 
of acute anaemia of the brain in vertigo, and of attacks resem- 
bling apoplexy. Atrophy and hypertrophy do not usually 
involve the heart alone, but the whole muscular system. So 
with fatty degeneration ; it is simply a part of a wide-spread 
change of degeneration. Wasting diseases impair the integrity 
of the heart; so do fevers; but repair after these is swift and 
usually complete. Youth is not the season of fatty heart, unless 
broke down by debauchery and excess. The fatty heart is the 
concomitant of senile degenerative changes. 

There is a condition often mistaken for fatty heart because it 
resembles it, and may be called "heart starvation." This is a 
common malady. The assimilative powers are defective, espe- 
cially as regards the digestion of albuminoids; consequently 
the tissues are badly nourished, and the heart suffers especially. 
This cannot be a matter of surprise. The heart must work 
incessantly; so must the diaphragm, else the organism would 
perish. When other muscles are hungered they may rest, but 
these two must carry on their ceaseless round of duty. The result 
is, those two great muscles are starved. The heart's impulse is 
feeble and it sounds weak and ill-defined; the pulse is com- 
pressible, and other signs of a defective circulation. The impair- 
ment of the action of the starved diaphragm is seen in the diffi- 
culty of breathing produced. The mistake of recognizing a 
starved heart for a fatty one is often made. The following will 
guide to a correct diagnosis. In heart starvation there is no 
sign of degenerative change elsewhere; but there is loss of appe- 
tite, deficient hours of sleep, deficient action of liver, and sun- 
dry nervous symptoms due to defective nutrition of the nervous 
system; depression, irritability. The brain is under-fed and 
poisoned with the products of mal-assimilation ; the blood is 
charged with nitrogenized waste, and there is pain and spasm, 
due to the waste-laden blood poisoning special parts. 

Heart starvation is a disease of early and middle life — asso- 
ciated with overwork and deficient digestion — associated with 
mal-assimilation and not with degenerative changes in elderly 
persons. Hard drinking, where alchohol is taken in large 
quantities, leaves the heart starved, and ushers in true fatty 
degeneration as a sequel. Fatty decay is common in the drinker, 
because of the absence of albuminoids in the blood. Such fatty 
necrosis is common in some fevers, but is repaired when the 
assimilative processes are restored. The heart wants to be 
considered as a muscle liable to all the diseases of muscles and 
their effects, either in exhaustion or over-stimulation. Cases 



260 DISEASES OF THE ORGANS OP CIRCULATION. 

admit of great improvement by removal of causes ; good food, 
easy mind, tonics, and a general alterative course; change of 
air, avoidance of all excitement. 

DILATATION OF THE HEART. 

The use of tobacco is almost general throughout our country ; 
besides its action in contracting the cerebral convolutions and 
poisoning the brain, it has a most disastrous action on the 
muscle, of the heart, in enfeebling, softening and relaxing its 
structure, and diminishing its vital tonicity; and as a result 
we find cardiac dilatation very common. It presents itself in 
three different forms : 

1. Active Dilatation, in which there is enlargement of heart 
with dilatation, and when the expansion predominates over 
the hyperthrophy. 

2. Simple Dilatation, in which the thickness of its walls are 
normal. 

3. Passive or Attenuated Dilatation, the walls being thinned. 

Causes. — Mal-nutrition, or starved heart, or fatty degenera- 
tion, may operate as a predisposing cause; but sudden or violent 
muscular exertion, as running, jumping, rowing, lifting, strain- 
ing, etc., are common exciting causes. Besides, it is often a 
sequel of hooping-cough, asthma, emphysema, and it may arise 
from embolism, endocarditis or valvular disease. 

Symptoms. — The chief symptoms are, a small weak pulse, 
scarcely perceptible; coldness of extremities; giddiness, with 
pallor of features, deranged digestion; attacks of fainting; par- 
oxysms of asthma; restless nights; palpitation; dropsy of chest, 
abdomen and cellular tissues often present. The physical signs ; 
weak impulse, more like a tap, which imparts a thrill; first 
sound loud, short, sharp; second, usually weak. The area of 
dullness may be great, but there is no bulging out of ribs ; no 
loud audible beats; no numbness in left hand or arm, neither 
is the face congested; no epistaxis; nor near so much lung 
trouble as in enlargement. 

Treatment. — Rest of mind and body; good nourishing diet; 
bathing or sponging; secretions regulated; flannel clothing; 
prohibit tobacco, tea, coffee; all excitement, especially in going 
up stairs, straining, lifting, or sudden movements. A vegetable 
alterative and tonic course. Relieve symptoms. Give digitalis 
a fair trial for one or two years. Its action must be guarded 
and its physiological effect carefully noted. Aconite, cactus, 
menthol and cardiac drugs of little use. 

In addition to the use of the best of diet in all cases, there 
should be the most rigid avoidance of all alcoholic beverages, 
sexual excesses, or anything likely to bring about excitement, 
or quicken the circulation. 



DISEASES OF THE ORGANS OF CIRCULATION. 261 

CARDITIS. 

Myocarditis. — Inflammation of the muscular structure of 
the heart. 

An anomaly in disease, the inflammation of a muscle. In 
this case we have the old adage of a broken heart. The spleen, 
left kidney, all the abdominal viscera are in man freely sup- 
plied with branches of the great sympathetic as well as the 
face, larynx, lower lobe of right lung, and. above all, the heart; 
so that when the vital forces are subjected to the depressing 
influence of city life, solar heat, over- work or exhaustion, added 
to which an intense straggle for existence, we have the process 
of inflammation established in that organ. 

The first symptoms, aside from the ordinary languor, lassi- 
tude, debility, general prostration, is a sudden seizure of violent 
steady pain in the heart, out of all proportion to any other kind 
of pain; intense excitement, greatest anxiety; features change 
rapidly, become ghastly or cadavorous ; tongue coats rapidly, 
brown, dry, darkish ; breathing difficult, irregular, labored ; 
action of heart violent but unsteady ; rigors heavy, frequent ; 
and a fever of the highest possible kind, with great oppression 
about the chest; difficult respiration, dread of suffocation, 
alarming palpitation, delirium, extremities become cold, fits of 
syncope, pain in heart all the time increasing in severity. 

Its duration is from twenty-four to forty-eight hours, invari- 
ably terminating in death. The proper treatment to try, if 
seen early, would be wet cups over region of heart, followed by 
hot poultices in which opium is abundantly diffused. Then 
there are three drugs that act well on this part of the nervous 
organism, and they must be given often and in very large 
doses. 

Veratrum viride, five-drop doses, often and persistent. 

Pulverized opium in one-grain doses, but frequently, and 

Sulphate of quinine, in from ten to thirty-grain doses every 
three hours. 

The three drugs act harmoniously together; the opium pre- 
vents the veratrum from prostrating, and retains the quinine 
in the blood. To be successful, case must be seen early. 

ENDOCARDITIS. 

The endocardium, or the serous membrane which lines the 
interior of the heart, and which by its reduplication assists in 
the formation of the valves, and covers them completely, is fre- 
quently the seat of inflammation. 

The predisposing causes are the use of tobacco and other 
stimulants; over-work, nervous exhaustion, worry, grief, sor- 
row. The exciting cause is rheumatism or gout, or both. 



262 DISEASES OF THE ORGANS OF CIRCULATION. 

Symptoms. — In the acute form, there are the ordinary 
symptoms of languor and debility, with a deep-seated, sharp, 
lancinating pain away down deep, as the patient expresses it, 
in the heart, with great oppression and uneasiness over the 
region of the heart ; rigors and a fever ; pulse small, feeble and 
intermittent ; patient very restless and anxious ; prefers to lie 
on back ; great difficulty of breathing ; jactitation, cold sweats, 
fainting fits. 

If the vital power is greatly depressed, or constitution depraved, 
there may exist a true typhoid condition, with all its varied 
train of symptoms. If the endocarditis is of the subacute 
form, or what is more common, of a low chronic type, the 
symptoms will be less prominent, milder and more obscure, 
so much so, that patients attacked with rheumatic fever have 
endocarditis without being aware of its existence; neverthe- 
less, it is apt to leave structural changes on the valves that 
give rise to trouble. 

That portion of the endocardium lining the orifices and 
covering the valves most frequently attacked ; the left side of 
the heart more generally implicated. It is seldom directly 
fatal ; its effects, effusion of lymph, and its organization into 
cartilage or bone, or the effusion of urate of soda in gout, and 
its degeneration into a chalky concretion, most to be dreaded ; 
invariably gives rise to valvular disease. 

Place the hand over the region of the heart, it experiences a 
vibratory thrill ; no increased area of dullness ; place ear over 
heart, a soft, mitral, blowing murmur can be easily detected. 
Its duration may be months or years ; but its inevitable ter- 
mination is thickening of the valves, general loss of tone, 
obstructed circulation, impoverishment of blood, dropsy and 
sudden death. 

Treatment. — General attention to bowels, kidneys, skin; 
fever to be controlled with aconite, veratrum, opium, with 
tincture of bryonia, until there is a perfect amelioration of 
pain; repeated mustard plasters, followed with hot poultices, 
followed with croton oil, and irritating plaster to be worn for 
some months, or else belladonna plaster; perfect rest of mind 
and body ; nothing to fret, worry or cause anxiety ; diet to be 
good, light, nutritious ; treatment for rheumatism or gout to be 
carried carefully out ; convalesence to be established on vege- 
table alteratives, with iodide of potass and tonics; guarding 
against that twin-monster, rheumatic gout, by keeping the body 
covered with flannel, and avoiding everything likely to debili- 
tate. Forbid tobacco, alcohol, tea, excess, debauchery, etc. 

The very best of diet should be given, consisting of a mixed 
animal and vegetable kind ; and if unable to exercise massage 
should be resorted to morning and night. 



DISEASES OF THE ORGANS OP CIRCULATION. 263 

PERICARDITIS. 

Inflammation of the pericardium, or inflammation of the 
white fibrous serous covering of the heart or sac in which it 
hangs. Being a highly organized and perfect white fibrous 
tissue, it is most obnoxious to the poison of rheumatism, gout, 
urea in congested kidneys, ichorsemia, scurvy, etc. 

The most common predisposing causes are, tobacco, alcohol, 
tea, sexual excesses, nervous exhaustion, diseases of brain, 
struggle for existence, worry. These and like causes weaken 
the cardiac plexus of nerves, which, if once enfeebled, are very 
liable to be irritated by morbid states of the blood. 

The common exciting blood poison is rheumatism or gout, 
but other conditions of impure blood will also give rise to it. 

Symptoms.— There may be a general attack of rheumatism 
or there may not. An acute attack of pericarditis is usually 
ushered in with all the symptoms of fever ; first, languor, las- 
situde, debility, with sharp, lancinating pains in the peri- 
cardium ; pain in head, back, calves of legs ; rigors, and a fever 
of a high grade ; tongue coats heavily, urine loaded with uric 
acid ; the sharp, lancinating pain in the heart darts through 
to the scapula upwards to the left collar bone and shoulder, 
down the arm; the action of the heart becomes violent, 
tumultuous ; its action irregular ; the difficulty of breathing is 
often extreme ; inability to lie on affected side ; very much 
anxiety ; features become contracted ; there is great giddiness, 
noises in ears, bleeding from nose. As the case progresses 
there is extreme debility, cough, suffocative paroxysms, faint- 
ing fits, oedema of face and feet; often great restlessness, 
delirium, distortion of features, spasms or convulsions. 

In subacute and chronic cases the symptoms are so slight 
as scarcely to be suspected ; just a little pain, sharp, darting to 
shoulder blades, but effusion of lymph, which causes adhesions 
between the pericardium and heart, and organic disease, or 
effusion of serum, which, if copious, may fill up the pericardium 
and compress the heart, impede its movements, completely 
muffiling its sounds to the hand or ear. 

It is easily recognized in any of its three forms by the pain 
— sharp, lancinating, darting in acute cases through to the 
shoulder blades up to the clavicles. In the acute and sub- 
acute form a friction sound can be felt by the hand and heard 
by the ear; or if not that, an alternate rubbing to and fro 
sound ; friction sound, attended with valvular murmurs and 
excitement of heart. 

In the chronic or declining stage of an acute attack, serous 
effusion often takes place, when no friction sound can be 
heard, nor even the sounds of the heart itself, being muffled 



264 DISEASES OF THE ORGANS OF CIRCULATION. 

by the water or fluid, which, if great, may compress the heart, 
so as to cause weakness or paralysis. 

The duration of pericarditis depends much upon the treat- 
ment. With such improved remedies as we now have it 
should be short. 

Treatment. — The acute form is best treated as a case of 
acute rheumatism — perfect rest in bed, between blankets; heat 
to feet; open bowels with salines, milk and bicarbonate of 
potassa ; extract of beef for diet ; local stimulation over region 
of heart as long as can be borue with mustard, then hot poul- 
tices with opium; and then a reapplication of the mustard 
and poultices again and again. Aconite, veratrum viride and 
belladonna should be administered every half-hour, hour, or 
three hours, keeping the pulse at seventy. Three grains of 
Dover's powder, with one grain of pulverized opium, should 
be given at least every three or four hours, or oftener, the 
point aimed at being a perfect freedom from cardiac pain. 
Never let the sensorium feel the pain of an angry, irritable 
heart. Quinine must also be administered in large doses ; if 
there is any positiye idiosyncrasy to its use, the salicylate of 
quinine, or salicylate of soda, which have proved so remarkably 
efficacious in rheumatism, should be used. If the tongue 
cleans under those remedies, the best plan is to hold the posi- 
tion with them, with the exception that their doses should be 
reduced to ordinary standard, and the irritating plaster applied 
over region of heart. Then general anti-rheumatic treatment 
carried out with salicylate soda, colchicum, iodide of potass and 
quinine, mineral acids and other tonics. In the chronic 
form, irritating plaster over region of heart, general alterative 
and tonic remedies, with anti-rheumatic remedies, avoiding 
all causes that would be likely to enfeeble the heart. 

HYDROPS PERICARDIUM. 

Dropsy of the pericardium is invariably a result of peri- 
carditis. It is to be recognized by the history of the case — the 
cardiac expression of the features; difficulty of breathing, 
cough and general debility ; also, by the increased area of dull- 
ness on percussion ; by the sounds of the heart being muffled ; 
negatively, by the skin of the face being pale; no numbness in 
left hand ; by respiration, heart and pulse being low ; usually 
oedema of feet and legs. 

Treatment, same as for Dropsy, with the addition of the 
steady application of the irritating plaster over region of the 
heart, and the persistent use of the hair-cap moss in the form 
of an infusion. 

The diet here should be very generous, consisting of articles 
that can be converted into good, rich blood. 



DISEASES OF THE ORGANS OF CIRCULATION. 265 

FUNCTIONAL DERANGEMENT OF THE HEART. 

Requires a short notice, as it often so closely resembles organic 
disease of the heart. It is brought about in this way: the 
reflex centre, medulla oblongata, is weak from some cause or 
other, so are the various nerves that supply the heart. With 
a weakened bulb, any irritation in the body, such as worms, 
neuralgia, uterine irritation, or irritation of clitoris, penis, kid- 
neys, bladder, stomach, liver, will be easily and promptly trans- 
mitted to the centre, from thence to the heart, giving rise to 
this functional disturbance; nervous exhaustion, over-study, 
anxiety, sexual excesses, weaken the nervous centre. Tobacco, 
tea, whisky not only enfeeble the reflex centre, but devitalize 
the heart. Gout, rheumatism, syphilis, mercury act on the 
weakened cardiac nerves, circulating through them, poisoning 
them. 

Symptoms. — In the so-called functional derangement, we 
may have every symptom of organic disease, irregular pulse, 
palpitation, fluttering, with a cardiac murmur and subcuta- 
neous anaemia in anaemic subjects. Dull, weary ache over 
region of heart; occasionally sharp, lancinating, catching pain ; 
inability to lie on the affected side, owing to tenderness ; very 
great mental depression ; often dyspepsia, with heart-burn, 
flatulence, and eructations of gas or acid secretions ; vertigo, 
faintness, noises in ears, specks or spots before the eyes, flush- 
ing of face, violent palpitations, with pulsations in aorta. In 
women with uterine or ovarian trouble, or young men addicted 
to masturbation, smothering, difficulty of breathing, globus 
hystericus. 

Treatment. — Cases of this kind require fine judgment, long 
experience and keen observation. Symptoms must be relieved, 
for they are real, not imaginary, until the cause can be reached. 
If patient is intelligent his case should be fully explained to 
him. He must be told his nerve centres are feeble from some 
cause or other ; that his cardiac nerves have lost their tone ; that 
there is an irritation carried to the weakened but now highly 
impressible bulb, thence transmitted to the heart ; or that the 
nerves of the heart are starved from poor, or poisoned by bad 
blood. Once the cause can be removed there is usually little 
difficulty in the case, but that must be done. Investigations 
as to them embrace not a cursory but careful examination of 
lungs, stomach, liver, bowels, kidneys, genito-urinary organs, 
skin, blood, for irritation or disease ; and if no cause can be 
found, the case should be treated with alteratives and tonics, 
with irritating plaster over region of heart, and treatment per- 
severed with for months. At the same time every means 
should be adopted to invigorate the nerve centres with cinchona, 



266 DISEASES OF THE ORGANS OF CIRCULATION. 

ozone-water, and local stimulation to nape of neck. In all cases 
best of diet, daily sponging, gentle exercise, sea bathing ; tobacco, 
tea, alcohol, sexual excesses to be forbidden. 

ANGINA PECTORIS. 

Cardiac neuralgia, or as some term it cardiac epilepsy, from 
the fact that some cases are accompanied with a warning, a 
partial death of the cardiac nerves, in which severe intermit- 
tent pain is felt about the heart, with a sense of strangulation 
and a feeling of impending death ; occurs most frequently in 
advanced life; more common in men than in women. It 
seems to be associated with ossification of the coronary arteries 
and fatty degeneration. The cardiac nerves are specially 
involved in cases of ossification of the coronary arteries, as they 
are in such close proximity throughout their whole course, for 
these nerves not only accompany the arterial trunks, but pass 
into the muscular parietes of the heart along with the coronary 
vessels ; for nervous filaments can be traced as far as the third 
or fourth subdivision of the arteries ; here we lose sight of them, 
even in the largest animals. The pain radiates or shoots 
through the connection of the cardiac plexus with the spinal 
to the brachial and cervical plexus. 

Causes. — Disease of brain, morbid states of blood, stimu- 
lants, tea, whisky, tobacco, sexual excesses, mental excitement, 
heart starvation from impure blood, defect in organs of diges- 
tion and assimilation, mal-assimilation, heart badly nourished, 
over-exertion, mental or physical, loss of sleep, liver working 
sluggishly, brain under-fed, the weakened nerves of heart 
poisoned by products of mal-nutrition or disease-germs ; the 
waste-laden or disease-germ blood produces spasm, worry, 
struggle for existence, etc. 

Symptoms. — Generally the first attack comes on after ascend- 
ing some slight acclivity, or making some slight exertion, or 
after a meal. It comes on with a sudden seizure of excruciat- 
ing pain in the heart, shooting from the breast-bone to back, 
often accompanied by a feeling of constriction in the chest as 
if grasped by a vise. The pain is localized, still, it may shoot 
toward the shoulder, down the left or both arms, even down to 
the lumbar nerves. This brings the patient to a stand-still ; he 
fears to breathe, but if he chooses to breathe he can do so freely 
enough ; he feels a sensation as if of impending death, and a 
ghastly paleness overspreads his countenance. The pulse may 
be regular, or it may intermit or stop, or be feeble and irreg- 
ular. After a few minutes pain suddenly ceases, and the 
patient is well, but dreads another attack or a recurrence. At 
first there is often no lung difficulty, as asthma or emphysema 
or dyspepsia; it seems to be brought about by some trifling 



DISEASES OF THE ORGANS OF CIRCULATION. 267 

exertion, some emotional excitement of heart's action, but as 
it progresses it does not seem necessary to require an exciting 
cause, as it will come on when he is asleep, the patient waking 
up in a paroxysm of anginous pain — a pain so excruciating 
and commanding that no words can express its intensity ; it is 
appalling ; it unnerves the strongest mind, and death would 
seem to be preferable to such suffering. The sudden violent 
pain produces sickness, faintness, depression of heart's action, 
pale and anxious countenance, coldness, cold, clammy sweat. 
As the struggle passes off patient regains his usual health, 
often appears quite well. Whatever produces depression in 
the function of the fibres coming from the posterior roots of a 
spinal nerve, and as its result pain or neuralgia, produces also 
depression of function of motor fibres coming from the anterior 
root of the same nerve, and as its result sub-paralysis of the 
parts to which it is distributed. Hence we have in angina 
pectoris two distinct sources of depression of the cardiac action ; 

(1) we have the most depressing effect of a pain, the most 
acute and severe that the human body can experience ; and 

(2) we have the action on the cardiac motor ganglia of the 
same cause which, acting on sensitive nerves, give rise to this 
excruciating agony ; for we cannot suppose that the depression 
of motor is any less than the sensitive ones ; that is, that the 
epileptic paralysis of motion bears a relation to the acuteness 
of the pain, which is the index of the depression of the nerves 
of sensation. 

Should death take place as the result of an attack, the heart 
w T ill be found flabby, uncontracted, due to inhibitory paralysis. 
Death is not due to spasm, for if it was it would be instanta- 
neous ; whereas, it is gradual, a progressive lowering of the 
heart's action, becoming feebler and feebler until it ceases to 
beat. 

The main theories that have been advanced to explain the 
phenomena of the seizure are, spasm of the heart, depression of 
cardiac plexus, dilatation of heart, and ossification of coronary 
arteries. Pain is a symptom of variable significance here ; it 
is always intense, arising and ceasing suddenly, and accom- 
panied with a feeling of approaching death. 

Angina pectoris has no relation to fatty degeneration, in 
which there are faintings, cardiac asthma, feebleness of pulse 
or of the cardiac impulse, with yellowness or pastiness of the 
complexion, and an arcus senilis. 

Treatment. — This resolves itself into two distinct divisions 
during the fit and intermission. During the fit our measures are 
but palliative, but much more ample than what our forefathers 
possessed. They had only the use of external stimulants and 
narcotics — vain hope where minutes are precious. Modern 



268 DISEASES OF THE ORGANS OF CIRCULATION. 

discovery has changed all this. We now have remedies that 
can be administered by inhalation or hypodermic injection, 
that can give the patient instant relief of that terrible pain. 

Foremost among all our modern appliances for this dreadful 
breast pang, we place nitrate of amyl, a drug of great power, a 
volatile narcotic. To obtain a satisfactory result it must be 
fresh ; not kept in bottles, but in hermetically sealed capsules 
or pearls, a dose ranging from three to eight drops in each, 
opened, dropped on a piece of lint and inhaled. It is perfectly 
safe, and may be entrusted to the patient with the certainty 
that he will not injure himself by its use. It gives immediate 
relief, alleviates and removes the pain. It flushes the face, 
quickens the pulse, and lowers the blood pressure on the heart. 

If the nitrate is not procurable, or fails on account of its 
properties being lost in bottles, let the patient inhale a few 
drops of chloroform, and just as it begins to narcotize, inject 
hypodermically one-quarter of a grain of sulphate of mor- 
phia, so as to have the patient pass from the chloroform sleep 
into the morphia sleep, from which the patient will wake up 
in about eight hours free from pain, but exhausted. Is there 
no danger from chloroform in fatty or flabby heart ? No, not 
if carried to the point we desire. Nearly all cases of fatty or 
flabby heart are due to heart starvation, and are benefited by 
such a stimulant if carried to a certain point, just its slightest 
effect, from which the morphia at once reacts. No diseased 
condition need deter the careful and cautious use of the remedy. 
In reckless hands it is not safe, but with care it is all right. 
Angina is such a depressing disease that we need perfect nar- 
cotism of the nerve centres through which the action takes 
place — a perfect setting free from all depressing influences. 

Ether is also excellent, but not rapid enough in its action. 

Nitro-glycerine gives the'most complete relief in angina; one 
to two drops of a one per cent, solution in serious cases gives the 
most complete relief from pain. Administer in water, and con- 
tinue during the intermission thrice daily, increasing the dose 
to eight drops. It lessens the attacks, breaks their frequency 
and force. Lobelia, sumbul, and other antispasmodics are of 
little utility. 

However satisfactory our treatment may be with some of the 
above or other remedies during the paroxysm, it is during the 
intermission that the most striking results are to be obtained. 
During that period the most strenuous efforts must be made to 
improve the patient's general health, and especially to tone up 
his heart ; avoidance of cold, damp, strong exercise, walking 
after meals, sexual intercourse and mental excitement; rest, 
warmth in open air, driving or sitting is to be recommended. 
His diet must be regulated, to consist of the blandest, most nutri 



DISEASES OF THE ORGANS OF CIRCULATION. 269 

tious and unstimulating foods, as broiled beefsteak, boiled fish, 
eggs, milk, cream; avoid everything difficult of digestion, or 
that will give rise to flatulence, or stimulate and thereby weaken 
the heart. Prohibit tobacco, tea, whisky, etc., etc. The whole 
system must be attended to. Mild laxatives; an active skin 
by sponging and friction. A healthy stomach and liver does 
much to improve the tone of the heart, but a healthy brain 
and pure blood will aid more. The irritating plaster, two pieces 
an inch square, or else repeated small blisters of undoubted 
efficacy. 

A very persevering course of vegetable alteratives and tonics 
should be resorted to, as phytolacca and iodide of potassa, stil- 
lingia and iodide of sodium; mineral acids and cinchona, qui- 
nine and iron. Either the irritating plaster or belladonna plas- 
ter to be worn constantly over heart; the former is preferred; 
some are partial to the latter. 

While pursuing an alterative and tonic course, changing 
remedies weekly, and keeping two open sores at nape of neck 
freely discharging, then a special class of remedies are to be 
given to improve the faulty nutrition of the heart. We shall 
enumerate a few of those remarkable drugs : digitalis, arsenic, 
sulphur, quinine, phosphate of iron, nux vomica. Digitalis in 
small doses, not exceeding four drops of the tincture thrice 
daily, is invaluable in promoting the nutrition of the heart. 
Fowler's solution, in four-drop doses after meals, is invaluable 
in cardiac neuralgia and weak heart, being a special tonic to 
the nerves of the heart. Quinine, iron, hy drastin and nux increase 
the nerve nutrition, renders them less liable to pain, and are 
especially valuable in all cardiac neuroses. 

VALVULAR DISEASE OF THE HEART. 

Irritation of the endocardium by various blood poisons, as 
gout, rheumatism, and other poisons, gives rise to grave changes 
by the effusion of lymph and other deposits. We have also the 
effects of violent muscular exertion, as running, jumping, strains, 
lifts, as well as such diseases as asthma, hooping-cough, which 
give rise to effusion of lymph upon or beneath this serous inter- 
nal lining membrane. This membrane being reflected upon 
the valves, the latter lose their delicacy and transparency, and 
become thickened, puckered and often adherent to each other, 
and the tendinous cords become contracted. Independent of 
irritation and effusion, associated with or dependent on the 
internal lining membrane, the valves often become covered 
with warty vegetations or excrescences, or the seat of living, 
gout}^ and other deposits ; they are also liable to cartilaginous 
or osseous degeneration. 

The effects of these different deposits or thickening is either 



270 DISEASES OF THE ORGANS OF CIRCULATION. 

to contract or narrow the orifice, and so obstruct the passage of 
blood — called valvular obstruction; or by the thickening or 
degeneration of the valves, causing them to become shorter and 
thus prevent them from closing the orifice, and thus permit of 
regurgitation of blood, valvular insufficiency, or regurgitant 
disease of the valves. There may be only valvular obstruction 
or valvular insufficiency, or they may co-exist together. 

Causes. — The remote and predisposing causes are very varied, 
and embrace anything that enfeebles the heart, disease of brain 
or blood, but, more especially, tobacco; neither tea, whisky, 
excess, debauchery, tell so heavily on the heart as tobacco. The 
heart and its internal coverings weak, blood laden with acrid 
waste, acid, soda, lime, and other elements are easily and readily 
effused, which give rise to the difficulty. 

Symptoms. — Shortness of breath on slightest exertion, and 
as it progresses some difficulty of breathing ; palpitation and 
irregular action of heart, often intermittent, with sounds and 
murmurs distinctly heard when ear is over heart. If pulse 
does not intermit there is some change, — always some lung 
trouble, either congestion, bronchitis, chronic pneumonia, or 
pulmonary haemorrhage. Likely to be, if well established, 
haemorrhages from nose, bronchi or stomach ; swelling of the 
feet, sometimes arms and face ; dropsy of chest, sometimes of 
the abdomen. Quite a good deal of headache, with cerebral 
congestion and haemorrhage, vertigo, muscse volitantes, and 
noises in ears very common. Disturbed sleep, frightful dreams, 
spleen and liver suffer enlargement ; dyspepsia or disordered 
digestion. The features are contracted but puffed ; cheeks flushed 
and of a purple or livid hue ; lips congested or purple ; eyes 
bright, watery. As the disease progresses the patient becomes 
very feeble ; suffers from the slightest exertion, mental or phy- 
sical, or from the least exposure to cold or wet, or from the 
slightest error in diet. Death may take place from debility, 
or rupture of the heart, or from some of the complications that 
are so numerous in brain, lungs, liver, spleen, kidneys. 

On putting ear to the chest, over the first sound of the heart, 
systolic or contraction, or over the second sound, diastolic or 
opening or dilatation murmurs are heard. These murmurs 
may be harsh, or rough, or cooing, or whistling, or musical — 
modifications of little importance. Of whatever character a 
murmur may be, it is caused by a change or alteration of the 
valves, or orifices, or great vessels, producing an organic mur- 
mur. There is a functional or inorganic murmur produced by 
a diseased condition of the blood, — the lining membrane of 
the valves and orifices of left side of the heart much more fre- 
quently than the right. Signs of disease of the valves may 
be thus briefly given : 



DISEASES OF THE ORGANS OF CIRCULATION. 271 

The apex of the heart in the act of contracting, striking the 
ribs, is called the systolic sound. Two inches and a half above 
it you hear a gurgling sound, which is. called diastolic, from 
the heart dilating. 

Aortic Obstruction. — Systolic murmur, often rough, at sec- 
ond intercostal space and along the aorta, subclavian, etc. Pulse 
regular, small and long 

Aortic Regurgitation. — Diastolic murmur usually smooth 
at second space and downward along sternum to apex. Pulse 
regular, jerking and collapsing. 

Also, in aortic disease, the left ventricle becomes hypertrophied, 
and the apex of the heart is displaced downwards. 

Mitral Regurgitation. — The most common form of valvular 
disease. Systolic murmur at and to the left of the apex beat. 
Pulse irregular in force and frequency, soft and weak. 

Mitral Obstruction. — Presystolic murmur at inner side of 
apex, frequently accompanied with thrill. First sound sharp. 
Pulse usually regular, but soft and weak. 

In mitral disease the right ventricle becomes hypertrophied 
in consequence of obstruction to the passage of blood through 
the lungs, and the apex beat is displaced to the left of its nor- 
mal position 

Tricuspid Regurgitation — Usually comes on after mitral 
obstruction or regurgitation. Systolic murmur near ensiform 
cartilage. Pulsation in jugular vein. 

Semilunar valves of pulmonary artery may be supposed to 
be diseased when the blowing murmur can be traced from the 
middle of left edge of sternum up towards -left clavicle, and 
when this murmur cannot be heard in subclavian or carotid 
arteries. Pulse remaining unaltered. 

To determine accurately systolic or diastolic character of a 
murmur, the apex beat or the pulse should be carefully noted 
during auscultation. If systolic, the murmur must be synchro- 
nous with carotid pulse; if diastolic, after it; if presystolic, just 
before it and running up to apex beat. 

Treatment. — There are four indications in the treatment to 
be faithfully carried out : to abate any inordinate excitement ; 
to ward off or relieve all complications, as the result of the 
cardiac disease, as lung congestion, pneumonia, haemorrhage ; 
congestion of liver, kidneys, spleen, drops} 7 ; to nourish, tone 
and strengthen the heart ; to administer alteratives and tonics 
to remove the cause upon which it depends. 

The use of digitalis, aconite, belladonna, cactus grand, and 
bromide of potassa are to be used cautiously. They are of great 
value. We must support the powers of life well and relieve all 
complications as they arise. Light but highly nutritious diet, 
with proper attention to bathing, clothing, and a removal of all 



272 DISEASES OF THE ORGANS OP CIRCULATION. 

causes that would be likely to enfeeble the heart, brain ; a vege- 
table alterative and tonic course, keeping the irritating plaster 
applied over heart. 

In order to more clearly diagnose organic affections of the 
heart, the following rules might be borne in mind : 

1. In health, the cardiac dullness or percussion measures 
four square inches, or the closed fist of the patient; any dull- 
ness beyond that indicates either an increase in the size of the 
organ, or dilatation, or else a distension of the pericardium 
with a fluid. 

2. The heart has two sounds and two intervals ; the duration 
of each in health is the same; the first sound is when the apex 
strikes the ribs in the act of contraction, called systolic, two 
and a half inches above; after the interval is heard the heart 
opening, blood rushing, called diastolic. The first sound, sys- 
tolic, an interval of some length, then diastolic, then interval, etc. 
The apex usually strikes the ribs between the fifth and sixth, a 
little below left nipple. 

A friction murmur, synchronous with the heart's movements, 
indicates pericardial inflammation. 

A bellows murmur with the first sound, heard loudest over 
the apex, indicates mitral insufficiency. 

A bellows murmur with the second sound, heard loudest at 
the base, indicates aortic insufficiency. 

A murmur with the second sound loudest at the apex, indi- 
cates either (1) aortic disease, the murmur being propagated 
downward toward the apex; or (2) roughened auricular surface 
of the mitral valves; or (3) mitral obstruction, which is always 
associated with insufficiency, when the murmur is double, or 
occupies the period of both cardiac sounds. 

A murmur with the first sound, loudest at the base, and 
propagated in the direction of the large arteries, is more com- 
mon. It may depend (1) on an altered condition of the blood, 
as in anaemia; or (2) on dilatation or disease of the aorta itself; 
or (3) on stricture of the aortic orifice, or disease of the valves, 
in which case there is insufficiency, then the murmur is double, 
or occupies the period of both sounds. 

Hypertrophy of the heart may exist independent of valvular 
disease. When it does take place, it is usually the left ventricle 
that is affected, and usually in connection with mitral or aortic 
disease; in the one the hypertrophy is uniform with rounding 
of the apex; in the latter there is dilated hypertrophy with 
elongation of the apex. 

In addition, the nature of the pulse at the wrist; the nature 
of pulmonary or cerebral symptoms. 

Congenital Heart Disease — Is quite common, and has its 
origin in an arrest of development or malformation of some 



DISEASES OF THE ORGANS OF CIRCULATION. 273 

part of the organ, or in inflammation of its growing structures, 
or in a combination of causes; and it is really impossible to lay 
down rules for their diagnosis. 

CYANOSIS. 

The most common form of congenital heart disease, charac- 
terized by a blue or purple appearance of the skin, arising from 
some deficiency or defect in the construction of the heart, as 
from the septum not arriving at its full development at birth; 
or from permanence of the foramen ovale allowing a passage 
of blood between the auricles; or from the origin of aorta and 
pulmonary artery from a single ventricle; or from contraction 
of the pulmonary artery — any condition permitting a mixture 
of venous and arterial blood. 

Symptoms. — Blue color of skin ; coldness of body, tempera- 
ture often as low as 71° Fahr.; great difficulty of breathing,, 
fainting on movement or excitement, violent palpitation; tips 
of fingers and toes become bulbous, nails incurvated ; imperfect 
development; dropsical effusions, mostly congenital; if so, 
patient blue all over, often present at the termination of 
valvular disease. 

Treatment. — If it is a congenital affection, the best plan is 
to be cautious in any opinion of the case. Keep the little 
patient warm, nourish with mother's milk, or otherwise 
administer one or two drops of tincture of digitalis three times 
a day; and in a large proportion of cases, in a few weeks or 
months, the digitalis will contract the orifice and cure the 
affection. 

When it appears in chronic organic disease of the heart, alle- 
viate the symptoms as well as possible; give plain, nourishing 
food, mild tonics; warmth and warm clothing; rest, avoidance 
of fatigue, freedom from mental excitement. 

RUPTURE OF THE HEART. 

Rupture of the heart may occur from previous disease, or it 
may be caused by external violence. It ma; take place at any 
part, left or right side, walls of ventricles, rupture of valves, etc. 
Laceration of muscular walls, generally due to fatty degenera- 
tion, or to rupture of aneurism in ventricular wall. It is a 
common termination in dilatation with thinning of its walls. 
Embolism of the blood, such as we have in acute laryngitis^ 
pneumonia, and also in ergotism in labor, as well as that due 
to eating bacterial food, as sausage, is a common cause of rupture. 
The condition of embolism is so common from sluggish livers, 
non-ceration of blood by lungs and skin, and the muscular 
structure, feeble by excesses and tobacco, that rupture of the : 
heart as a cause of sudden death is fearfully prevalent^ 

30 



274 DISEASES OF THE ORGANS OF CIRCULATION. 

CANCER OF THE HEART. 

Cancer of the heart is extremely rare; it may be suspected if 
the diathesis exists, and there is pain anterior and posterior. 
Its most common form is as an infiltration of the muscular 
walls, or as a separate growth in the form of a tumor. Cancer 
of the pericardium is more common than in or on the heart 
itself, and usually of the acute or medullary form. 

Enforce general treatment for Cancer. 

AORTITIS. 

Acute inflammation of the aorta is a very rare affection, and 
when it exists it is always either dependent on or associated 
with rheumatism. 

The symptoms are very obscure ; great and general uneasi- 
ness, followed by rigors and a fever; extreme difficulty of 
breathing, with an impending sense of suffocation ; excruciating 
pain and violent pulsation in vessel; palpitation violent; loud 
systolic sound ; pulse may be unaffected. 

The appearance after death exhibits great changes in the 
coats of the vessel, the result of inflammatory action ; often struc- 
tural lesions or degeneration of tissue ; osseous, amyloid, fatty, 
calcareous and other forms of degeneration. 

Treatment. — Free purgation, active diaphoresis by injecting 
hypodermically one-third of a grain of pilocarpin. Wet cup- 
ping over heart, followed with hot poultices, veratrum viride, 
opium and quinine, same as in Pericarditis. Then salicylate 
soda, colchicum, iodide potass, and general use of remedies for 
Rheumatism. 

HYDROTHORAX. 

The presence of water in the cavity of the chest may be 
either the effect of pleurisy or obstruction in the heart, as in 
valvular disease. When a result of pleuritic inflammation it 
is due to effusion ; when due to organic disease of the heart 
exosmosis takes place. 

The presence of water in the cavity of the chest is easily 
made out. There is great difficulty of breathing when the 
patient lies down, in which position the lungs are clear from 
top to bottom ; being permeated with air they float on the top 
of the water; sit the patient up and percuss, there is dullness 
at the base of the chest, extending upwards. If the patient is 
of a spare habit a splashing sound may be detected by shaking 
the patient in sitting posture. 

This form of dropsy admits of removal without operation in 
the large percentage of cases if due to pleurisy ; but if it 
depends on organic disease of the heart the water may be 
removed, but returns again and again. 



DISEASES OF THE ORGANS OF CIRCULATION. 275 

Treatment. — In the cure of all cases of dropsy it is of para- 
mount importance to maintain a high standard of health, to 
keep the blood rich in fibrin and red corpuscles, with the best 
of diet and remedies to aid digestion and promote assimilation. 

In all cases the patient should be placed upon infusion of 
digitalis for a week, to astringe the blood-vessels and unlock the 
absorbents, and then diaphoretics, diuretics and hydragogue 
cathartics administered, such as warm baths, jaborandi, squills, 
broom, nitrate potassa and elaterium. That class of remedies 
failing, alteratives and absorbents, as iodide of potass. See 
general treatment for Dropsy. 

ANEURISM. 

A swelling, pouch, sac or tumor, caused by the dilatation of 
the coats of an artery. It may embrace one or all the three 
coats of the vessel, and may extend a long distance. When 
all the coats of an artery are dilated, but not ruptured, it is 
called a true aneurism. Dilatation, with rupture of one or more 
coats, constitutes a false aneurism. The internal and middle 
coats are frequently ruptured or removed in patches by the 
detachment of foreign particles or the burrowing of disease- 
germs ; the blood then comes in contact with the external 
cellular sheath, dilating it into a pouch or sac. The external 
walls of the tumor in this case condenses, acquires a covering 
by effused lymph, and becomes thick; and if the patient enjoys 
average health, the sac will become very firm. The division 
or rupture or tear of an artery may result in extravasation of 
blood into the areolar tissue, and thus form a diffused aneurism. 
Varicose aneurism can only happen when a vein runs over an 
artery, as when the brachial is punctured in opening a vein. 
The blood rushes into the vein, rendering it varicose; naevus, 
or aneurism by anastomosis, so common on the heads of children. 

Causes. — The absence of support, inherent weakness of 
organization, a weakened or diseased state of the walls of blood- 
vessels, the deposit of morbid matter in the blood on the walls 
of an artery, as particles of starch, fat, calcarea, tubercle, and 
these, being washed away by the current of the circulation, leave 
the spot to which they adhered weak or ulcerated, and impaired 
the elasticity and vital power of resistance of the vessel ; when, 
if the circulation is excited by mental or physical exertion, 
as coughing, straining, lifting, hoisting, pulling, rowing, jump- 
ing, the force of the circulation presses heavily on the weak- 
ened part, and a bulging or aneurismal sac is formed. Morbid 
states of blood are favorable for aneurismal tumors. If they 
arise from local violence, they are called traumatic, and spon- 
taneous when they arise without local injury — a distinction of 
no moment. 



276 DISEASES OF THE ORGANS OF CIRCULATION. 

Symptoms. — A sac, pouch, swelling or tumor, pulsating 
synchronously with the action of the heart, located over an 
artery, which, when equally compressed, is emptied of its con- 
tents, and when pressure is removed the blood rushes in with a 
whirring sound. They tend to increase in size, and if near the 
heart give rise to different morbid states of that organ. 

Treatment. — Men, from their more laborious mode of life, 
are more obnoxious to aneurisms than females, and are better 
subjects for a spontaneous cure by coagulation, as their blood 
contains more fibrin and a much greater percentage of red 
corpuscles than women ; we shall briefly enumerate the various 
methods of treatment before speaking of nature's method. 

A ligature applied to the main trunk of an artery cuts off 
the circulation, the pulsation in the sac at once ceases, a coag- 
ulum is formed, which, if vital force is good, is gradually 
absorbed, and the whole mass degenerates into an impervious 
cord, the circulation being carried on by the collateral 
branches. This may all look well, but if there is disease of 
the artery, as there often is, a union of its internal coats may 
not take place, and when the ligature sloughs off in one or two 
weeks, secondary haemorrhage and death ; besides, it is only on 
the thigh in Scarpia's triangle, or in the arm over the brachial 
or about the head that it can be applied. It is not adapted 
for the internal forms which are so common. 

Pressure, where it can be applied, is of great efficacy in 
diminishing the flow through the sac. It gives the fibrin of the 
blood a chance to coalesce and cause coagulation, which is ulti- 
mately absorbed. Electricity, applied by means of several needles 
inserted into the aneurism, produces instantaneous coagulation 
of its contents. It is best adapted to small tumors. 

Nature's method is the best. Fibrinize the blood, restrain the 
circulation, and coagulation is certain. Begin by the adminis- 
tration of a rich animalized diet, beef, eggs, milk, cream. Im- 
prove the digestive organs and increase fibrin in blood with 
nitro-muriatic acid and compound tincture cinchona, or aro- 
matic sulphuric acid and quinine. After a few weeks, enjoin 
absolute rest of mind and body, and put patient on digitalis 
to keep pulse at sixty, steady. Fresh rich food, no alkalies, nor 
do not use aconite, nor veratrum viride, nor belladonna; for 
however valuable their action on the heart may be they keep 
up fluidity of blood. After the pulse has been kept at sixty, 
under care of a skilled nurse for one week, use either ergot or 
carbolic acid internally for about a week, and coagulation of 
contents of the sac is almost certain. Under such treatment 
patient must retain the recumbent position, as that slows the 
heart's action about twelve per minute. The digitalis must be 
administered in from eight to fifteen drops in water, every three 



DISEASES OF THE ORGANS OF CIRCULATION. 277 

hours, never permitting contractions to exceed sixty. This drug 
not only slows the heart, hut contracts or astringes the heart, 
arteries and veins ; their calibre is smaller, and the tendency 
is, for the blood, if rich enough, to clot in hollow organs, as the 
aneurism. This clotting begins on the walls of the aneurism 
and gradually merges to the centre until a clot forms. The 
ergot or carbolic acid must be very carefully watched, and dis- 
continued if any bad feelings are experienced about the heart. 
Of all methods this is the best. 

CARDIAC ANEURISM. 

Aneurism of the heart is found in two forms: 

1. The acute variety depends on a laceration of the endo- 
cardium and muscular tissue, through which the blood passes 
to form a pouch. In this pouch fibrin is deposited, while at its 
entrance is a fringed margin with vegetations attached. 

2. The chronic form results from some inflammatory con- 
dition of muscular fibre or endocardium. "Walls of sac consist 
of endocardial and pericardial membranes unbroken, while 
the muscular fibre seems to be replaced by a fibroid tissue. 
Either kind gives rise to obscure and uncertain symptoms ; 
passage of blood into sac may cause a murmur. Death usually 
occurs suddenly from rupture. 

Aneurism of coronary arteries is not infrequent. 

ANEURISM OF THORACIC AORTA. 

The symptoms of this form of aneurism are often obscure in 
their early stages, bearing a strong resemblance to disease of 
the heart. If the aneurism al tumor be large and is developed 
quickly, there is disturbed action of the heart, with some modi- 
fication of radial pulse; dullness on percussion around portion 
of vessel from which aneurism springs; cough; wheezing; diffi- 
culty of breathing; spitting of blood; difficulty and pain about 
back and chest ; superficial veins of chest and neck swollen. 
If the aneurismal tumor becomes very large and pulsating, 
rises out of the chest, producing protrusion of sternum and 
ribs, then the diagnosis is easy. If the aneurism presses upon 
the trachea, there is difficulty of breathing and cough; when 
on one or both recurrent laryngeal nerves, aphonia, with trouble- 
some cough, severe paroxysms of laryngeal suffocation, pain 
coming on at intervals; when on oesophagus, symptoms of diffi- 
culty of swallowing, engorgement of absorbent vessels and 
glands, inanition, and symptoms of stricture. If the aneurism 
is in the ascending, near to the heart, the patient suffers from 
angina pectoris, resulting from pressure on the plexus of nerves, 
ramifying on each side of the aorta and communicating freely 
with the cardiac ganglia and plexuses of the ventricles. 



278 DISEASES OF THE ORGANS OF CIRCULATION. 

Contraction or dilatation of pupil on the affected side, accord- 
ing as pressure is sufficient to irritate or paralyze branches of 
sympathetic nerve. Often blowing murmurs can be detected. 
If the heart be compressed by a tumor, so as to impede the 
action of the valves, a systolic or diastolic murmur will result. 
Pressure on aorta or on pulmonary artery may produce a 
murmur. In false aneurism there is generally a murmur both 
with entrance and exit of blood into the sac; or there may be 
one loud and rasping murmur from the passage of blood over 
the roughened inner surface of the vessel. In true aneurism, 
or the mere dilatation of a part of the wall, murmurs seldom 
audible. Even a small opening into the canal of an artery 
into aneurismal sac, and a roughened state of the arterial 
tunics from degeneration, will give rise to a murmur. A pecu- 
liar thrilling or purring tremor is often felt over the sternum. 

The termination may be death from rupture externally, or 
into pericardium, or into the pleural cavity, or into the trachea, 
or into the bronchial tube; or the patient may die from 
exhaustion consequent upon long-continued suffering, or there 
may be a fatal destructive inflammation of lung, owing to the 
compression of pulmonary vessels or pressure on pneumogastric. 

ANEURISM OF ABDOMINAL AORTA. 

Very common in ladies from falls, lifts, strains, and bearing 
down efforts in labor. Patient describes it as a feeling as if 
something had given way ; most generally met with just behind 
stomach. It exists from a mere distension of the descending 
aorta to a large sac ; machinist, especially those pulling long 
heavy bars of steel are common sufferers. 

Empty the bowels ; see the patients before they partake of 
.food; lay them on back, knees drawn up, and the tumor can 
be easily made out. If large enough to interfere with the 
vermicular movements of the stomach, the case is not so favor- 
able for a cure. If that organ is undisturbed, treatment will 
soon do its work in effecting a speedy cure. 

In aneurism in chest or abdomen all bodily and mental 
excitement must be avoided, all prominent symptoms alle- 
viated; generous, reparative diet to be allowed ; not over one 
pint of fluid to be used per day ; great attention to the secret- 
ing and excreting functions, and in the abdominal, the method 
of treatment by slowing the heart and fibrinizing the blood 
resorted to. 

NiEVUS. 

Aneurism by anastomosis, or mother's mark, a formation of 
dilated arteries, veins or capillaries. 
Arterial Naevi, met with most commonly in infancy and 



DISEASES OF THE ORGANS OF CIRCULATION. 279 

youth. The diseased vessels "become enlarged, elongated and 
tortuous, forming tumor variable in size, irregular in shape, 
spongy, compressible and pulsating — a murmur being audible. 

Venous Naevi give rise to irregular tumors of a purple 
color, which feel doughy, and are diminished in size by pressure. 

Capillary Naevi are most common ; for the most part they 
are congenital, begin usually as a red or purplish spot, which 
gradually spread. They are generally met with on the scalp, 
or face or neck ; rarely on other parts, and involve skin or 
subcutaneous parts, and of all sizes, from a strawberry up. 

Treatment. — When very small and producing no disfigure- 
ment, and not increasing in size, they are best left alone, as 
nature often affects a spontaneous cure by a coagulation and 
absorption of their contents. 

There are several methods of treatment, as removal by the 
knife, or ligature, which is rarely advisable; destruction with 
caustics, as brushing it over with ethiate of sodium, or nitric • 
acid, or superphosphate of zinc ; electrolysis and coagulation 
of blood by galvanism, or in the application of remedies to 
excite adhesive inflammation, as injecting with perchloride 
of iron, or vaccination with croton oil, or painting with col- 
lodion and tannic acid, painting with tincture of iodine. 

PHLEBITIS. 

Inflammation of veins, with coagulation of blood in them. 
Nothing so likely to cause this form of partial death as the 
living germs of disease — the degraded living matter on an 
imperfectly cleaned lancet or bistoury, dissection wounds, mor- 
bid discharges. A very common cause is the lochial discharge 
from parturient women; hence, physicians, nurses, washer- 
women are often affected, especially if they have scratches or 
abrasions about the fingers. In some cases the bacteria are so 
numerous that the immersion of the hands in the water in 
which the clothes are soaked is sufficient to excite phlebitis. 

To the veins that take up this living matter it acts as a pow- 
erful depressent, and induces not only a coagulation of the 
contents of the vein, but an active inflammation of its coats ; 
the bacteria or micro-organism that causes the coagulation, 
also, by rapid increase, disseminates itself throughout the blood. 

The cause is the degraded living matter in the germ bac- 
teria. No other germ produces such pathological results; 
hence the secretions of erysipelas, puerperal or lochial, or 
furuncular patients are most virulent. 

Symptoms. — The veins at once, that is, after the inocula- 
tion or absorption of the living matter, become very painful, 
thick, cordy, swollen, pain aggravated by movement or press- 
ure; stiffness and redness supervene along the entire course 



280 DISEASES OF THE ORGANS OF CIRCULATION. 

of the affected vessel, first extending to the elbow, then up 
the arm ; very prone, if not energetically treated, to terminate 
in suppuration ; if so, there are rigors and flying pains in 
different parts of the body, with great constitutional dis- 
turbance and fever of a nervous or irritative type. When 
suppuration and abscess take place the coats of the vein ulcer- 
ate, and the contained clot is discharged by means of an 
abscess. The bacteria or germ -poison does not produce coagu- 
lation ; it mixes with the blood, rendering that fluid a river of 
disease-germs, affecting the entire body, and giving rise to 
bacterial deposits in weakened parts, with embolism and 
abscess in vital organs, as the heart, lungs, spleen, liver, kid- 
neys, joints and areolar tissue. In some cases a clot is carried 
from the vein to the heart, and causes sudden death. 

Treatment. — The general management of such a case is 
of great importance; the suction and cauterization of the 
wound, the application of a solution of muriate of ammonia, 
and poultices with yeast and salicylate of soda. If the vein 
has become engorged, thick, cordy, the application of a row of 
leeches along it to empty it of its bacterial contents, and hot 
fomentations of ammonia or permanganate of potassa ; or if 
the clot in vein is so firm that the diseased blood cannot be 
drawn off, then to paint along the course of the entire vein 
with creosote, and then poultice with alkaline, antiseptics, as 
sulphite of soda, tincture iodine in lime-water, etc. The creo- 
sote permeates the walls of the vein, kills the bacteria, and 
the blood regains its fluidity. It penetrates better than car- 
bolic acid, and is just as effectual in annihilating the micro- 
organisms. Internally, acro-narcotics, as opium and bella- 
donna in alternation; the former to relieve pain, the latter to 
maintain the fluidity of blood. Otherwise the case should be 
treated with a free use of antiseptics, those possessing alkaline 
properties, as ammonia, chlorate or permanganate of potass — 
sulphite of soda or lime should have a preference. Suitable 
doses of quinine should also be given. The patient should be 
well nourished with essence of beef, eggs, cream, lime-water 
and milk, and a total alleviation from suffering. 

Other Antisepdics sometimes used — salicylate of soda, carbolic 
acid and tincture of iodine. 

PHLEGMASIA DOLENS. 

Phlegmasia dolens, or milk leg, is due to the micro-organism 
bacteria. During parturition, especially if labor has been severe 
or prolonged — a condition in which the vital integrity of the 
uterus has suffered ; or it may be a case in which ergot has 
been given, perhaps rather freely or injudiciously, which not 
only causes contractions of the uterus, but in itself supplies 



DISEASES OF THE ORGANS OF RESPIRATION. 281 

the blood with bacteria, thus engendering embolism ; or it might 
be a uterus contracted firmly on a placenta or clot, which 
squeezes diseased products into sinuses of left side, which is the 
weakest, causing irritation of ovary and poisoning of veins of 
the left leg, coagulation of their contents; embolism takes place 
within the external iliac and femoral veins, causing a brawny, 
painful swelling of the entire extremity. 

Symptoms usually commence from one to six weeks after 
labor. On its first appearance there are rigors, fever, thirst, 
nausea; great pain, swelling, loss of motion of the affected 
extremity; limb hot, tender, non-oedematous, but swollen and 
twice its natural size, of a pale white color, tense and elastic, 
having a glazed and shining appearance; and even after acute 
symptoms have subsided, the limb remains enlarged for many 
weeks, even months. 

In some cases of uterine cancer the same condition may be 
induced. 

Treatment. — Here we have some difficulty, as we are unable 
to empty the veins by leeches, and the affected vessels are too 
deep-seated to be affected by creosote, so that 'we have to be 
satisfied with shampooing the limb twice daily with vaseline 
or ozone liniment, manipulating up to the body in keeping the 
entire extremity encased in a roller from the great toe to the 
groin, and the roller kept saturated with a solution of acetate 
of ammonia, or vinegar and nitrate of potassa with tincture 
of opium, covering all over with oiled silk to prevent evapora- 
tion, keeping the limb higher than the body. Internally, opium 
freely to relieve pain, and belladonna to maintain fluidity of 
blood ; otherwise, the treatment consists in the judicious use 
of antiseptics to destroy the bacteria, and a nourishing course 
of treatment to sustain the powers of life. 

When the living matter of our own bodies is altered into a 
disease-germ or bacteria, the germs are naked, that is, they are 
unprotected by a cell wall, so that they are exposed to the direct 
influence of any antiseptic that may be brought to bear on 
them; while, on the other hand, the normal bioplasms of the 
tissues are well protected by the material around them. In other 
words, an efficient protection surrounds all high-graded living 
matter; so that in the use of antiseptics we soon see big results 
in germ diseases. Select an alkaline antiseptic, as acetate of 
ammonia, carbonate of ammonia, chlorate or permanganate of 
potassa, sulphite of soda, chloride of lime, iodide of potassa, 
tincture of iodine, vegetable alteratives and tonics. 

During the febrile stage, the diet should consist of lime-water 
and milk, in alternation with beef tea; when fever subsides, 
diet should consist of animal food, beef, mutton, poultry, abun- 
dance of fresh vegetables and fruit. 



282 DISEASES OF THE ORGANS OF CIRCULATION. 



VARIX. 

A varicose or dilated condition of veins. The predisposing 
cause is inherent debility, and the exciting cause, anything that 
retards the return or flow of blood to the body, as standing, 
loaded bowels, pregnancy, corpulence, straining. 

In the treatment of varix, improvement of the general health, 
a regular action of the bowels to be procured ; tonics and good 
diet. Our best remedy, both internally and locally, is haina- 
melis. Locally, mechanical support, as bandages, elastic stock- 
ings. Obliteration of veins not attended with any good results, 
as the deeper-seated vessels become implicated. 

Varicose Veins are most commonly met with on the leg, 
and on the spermatic cord and testicle. 

They are invariably the result of inherent debility. When 
varicose veins appear on the leg, the deeper seated veins are 
usually first afTected; the deeper seated and not the superficial 
veins being thus first implicated with valvular inefficiency and 
dilatation — and then these two conditions spread to the super- 
ficial. This condition harmonizes with the special arrangement 
of the venous system of the lower extremity. 

These facts throw more light on the subject of varicose veins, 
and elucidate a newer and more correct treatment and a bet- 
ter choice of remedies. 

The Treatment of Varicose Veins of the lower extremity 
should consist in the removal of the cause, if admissible, and 
a course of alteratives and tonics, with the very best of diet. 

The afTected limb should be bathed morning and night, and 
rubbed well towards the body. After being thoroughly dried, 
it should be freely saturated with some astringent wash, such 
as a decoction of witch hazel, or white pond lily, or white oak 
bark. After one of those remedies has been well rubbed in, 
limb dried, then encased in a fine stocking, then over and above 
all an elastic stocking or bandage should be constantly kept 
on, so as to give support and hasten the languid circulation 
onwards. Remedies should be changed at least every week. 



DISEASES OF THE ORGANS OF PvESPIRATION. 283 



DISEASES OF 

THE ORGANS OF RESPIRATION. 



OLFACTORY NERVE. 

The first cranial nerve is not of such vital importance as the 
auditory, or optic. In the Caucasian, it may be said, to exist 
in a refined but very rudimentary condition; whereas in the 
colored races it is peculiarly large and well developed, probably 
two-thirds greater than in the white. In animals, and some 
fishes, as the shark; it is immense in the latter, being reflected 
over twelve square feet of mucous membrane. The peculiar 
structure of the cavity of the nose shows that there is one nerve 
for sensation and another for olfaction — that the lower portion 
of the nose possesses epithelial cells; the upper portion pigmen- 
tation, the latter lying in grooves. In ordinary quick breathing 
little air enters these olfactory channels, for most of it passes 
through the posterior nares into the pharynx. If we desire to 
smell keenly, we instinctively resort to the use of the dilator 
muscles of the nose, whereby the olfactory channels or grooves 
are opened or enlarged. This nerve gives us protection against 
poisonous gases, but does not in all cases prevent their absorp- 
tion, although not near so active as the salivary glands of the 
mouth. 

The specific stimulation of the olfactory nerves are, odorous 
gases, scents, and odors of flowers, which come in contact with 
the flattened-out ends of the olfactory, causing a peculiar vibra- 
tion in the molecules of the nerve, which is transmitted to the 
brain, where it is appreciated. The sense of smell is often lost 
in catarrh polypus in the olfactory channel, also, in injury to 
the head or nose; disease of brain may exalt or destroy smell. 
Inflammation of nerve is rare. The nerve may be absent or 
but very rudimentary, or it may be covered over with lymph, 
or destroyed with ulceration; and owing to these states, there 



284 DISEASES OF THE ORGANS OF RESPIRATION. 

may be an entire absence of smell, anosmia; or from a high 
state of nervous development the sense may be very keen, 
excessively sensitive, Jnjperosmia. 

As far as our present knowledge goes, there are only two 
remedies which have a decided and antagonistic influence on 
olfaction. Strychnine will exalt, while morphia will impair and 
deaden it. Strychnine rubbed up in some inert body and used 
as a snuff, or taken internally in suitable doses, wonderfully 
increases the keenness of the sense; the snuff is the most effec- 
tive. It acts so well that it causes a sensitiveness to pungent 
odors, almost amounting to pain; whereas, morphia confuses 
the appreciation of odors to such an extent as to produce a 
kind of chaos. The olfactory nerve is narcotized, and odors 
appear at an enormous distance. Other remedies possessing 
analogous properties have a lesser influence; belladonna causes 
dryness, and pilocarpin the opposite state; both conditions unfa- 
vorable for good smell. 

ACUTE NASAL CATARRH. 

Inflammation of the mucous membrane lining the nose, 
frontal sinuses, throat, accompanied with fever. The cause is 
usually exposure to cold or wet. 

Symptoms. — Languor, lassitude, debility; pain in head; 
aching in back and limbs ; fever, thirst, loss of appetite, rapid 
pulse, increased heat, coated tongue, discharge from nostrils; 
profuse lachrymation, hoarseness, sore throat. 

In addition to those symptoms, the discharge from the nose 
is liable to become acrid, and coming in contact with the lips 
causes an eruption of fever blisters or herpes. In a few days 
s} r mptoms will subside and pass into a subacute form, and 
tonsilitis or bronchitis may supervene, and the patient recover. 
If he happens to be feeble, or possess a tubercular habit, it may 
pass into ulceration, and a chronic form be set up. In all cases 
there is a degradation of the living matter that supplies the 
mucous membrane of the nostrils, frontal sinuses, posterior 
nares, and throat, into the disease-germ, amoeba, which, if not 
speedily relieved, will produce grave changes. 

Treatment. — Our dry, highly oxygenized atmosphere is 
favorable to the prolongation of cases of ordinary cold or acute 
catarrh, so that our treatment should be active, If the tongue 
is coated, an emetic, open bowels, give a warm alkaline or 
alcoholic vapor bath. Patient should go to bed in a room 
whose temperature is 75° Fahr., and the atmosphere of which 
should be loaded with steam or vapor, so as to diminish the 
oxygen, heat to feet, and general treatment for fever, aconite 
and belladonna. As fever subsides, tonic course, quinine and 
mineral acids, with very nutritious food. If there is a recur- 



DISEASES OF THE ORGANS OF RESPIRATION. 285 

rence, a general alterative course, as saxifraga, in alternation 
with glycerite of ozone, or kephaline, for a few months. 

CHRONIC CATARRH. 

A severe or else repeated attacks of inflammation of the lining 
membrane of the nose, sinuses, posterior nares, larynx and 
bronchi, so devitalizes, modifies, changes and degrades normal 
living matter into a diseased germ, — the amoeba, which is sim- 
ply a degradation of the normal bioplasm that nourishes the 
lining membrane of the respiratory mucous membrane, that 
gives us rather a complicated disease, one both contagious and 
infectious. We also find the disease-germ in the mouth, urethra, 
vagina, but always more perfectly developed and in larger quan- 
tities in the air passages. 

Chronic catarrh, then, may be defined to be chronic inflam- 
mation of the Schneiderian membrane, with this change of its 
own living matter or matter concerned in its nutrition, into the 
disease-germ, amoeba. It is most erroneous and unscientific to 
assert that it is caused by syphilis or tubercle. Those disease- 
germs may impair the vital stamina of the j)atient, but cannot 
produce the amoeba. 

Our highly oxygenized atmosphere, our very variable climate, 
the extreme susceptibility of our people to climatic changes, 
with our violent winds and atmospheric currents, absence of 
trees, etc., render our people very liable to catarrhal affections. 
The most careful microscopical examinations of an immense 
number of cases fail to exhibit any germ but the amoeba. When 
it occurs in a young or tubercular subject, the tissues being soft 
and not very vital, the amoeba of catarrh eats up the structures 
rather voraciously, and as soon as they reach the cartilages of 
the nose, all their proper nutriment being gone, (for they can- 
not live on cartilage), and the vital powers being very low, the 
oidium albicans makes its appearance; then we have that pun- 
gent, indescribable, foetid odor characteristic of ozsena. When 
the Schneiderian membrane and frontal sinus are alone impli- 
cated, with no appreciable odor, it is termed catarrh ; when the 
amoeba have crept up the eustachian tube, aural; when they 
have penetrated down the fauces and larynx, laryngeal; when 
they have moved still further downwards on the bronchi, bron- 
chial; asthmatic when they gnaw the periphery of nerves in 
the circular muscular fibres of the rings of the bronchi. 

Aromas or parasitical states, such as the bacilli of hay, the 
mycelia of roses, ragweed, and other vegetable germs, are not 
capable of living in human blood; nevertheless, they can blight 
normal bioplasm of the respiratory mucous membrane, and thus 
cause the appearance of the amoeba. Hence, catarrhal conditions 
are named after those special vegetable agents. Diseases of the 



286 DISEASES OP THE ORGANS OP RESPIRATION. 

respiratory mucous membrane are very prevalent, each capable 
of causing tuberculae : (1) by reflex action ; (2) by the amoeba 
entering the blood. 

Catarrh is often the starting-point, as it is the most common 
of the entire class. When it takes place, its offspring, the 
amoeba, begins to enter the blood and produce a special diathe- 
sis of its own. Its chief characteristics are languor, lassitude, 
debility; a peculiar pasty or doughy appearance of the skin ; 
pains in the limbs ; headache, with a sense of tightness across 
the forehead ; excessive muco-purulent discharge from the nos- 
trils, or trickling down the throat, (which creates hawking), 
loaded with amoeba; or if there is much oxydation, the dis- 
charge may dry up and become impacted in the nostrils. If 
the amoeboid colony runs up the eustachian tube, it will cause 
deafness; if it moves downwards, (for it is a living mass), hoarse- 
ness and aphonia; if still further down, on the bronchial tubes, 
increased hawking, cough, emaciation and discoloration of the 
skin due to imperfect oxygenization of blood ; if down the 
oesophagus, dyspepsia. As it is very liable to cause amyloid 
degeneration of liver and kidneys, there may be some swelling 
of cellular tissue and oedema of ankles. 

It is not only a contagious and infectious disease, but loath- 
some, and liable to give rise to so very many other affections, 
as epilepsy, consumption. It is nearly identical with glanders 
in the horse; it is simply a difference in size and virulence of 
the germ. In human catarrh the amoeba is a microscopical 
dwarf; in glanders in the horse it is a giant. 

Of all the disease-germs the amoeba is the most interesting 
to study. It can be seen with a low power, its movements and 
habits can be seen so accurately; even its mode of nutrition, 
opening and closing themselves to receive foreign particles, 
inclosing and appropriating them and even imbedding them 
in its very substance. As they enter the blood they no doubt 
impair the red corpuscles, and cause a peculiar form of anaemia. 

Treatment. — To treat catarrh successfully the patient must 
have the best of diet, secretions regulated, warm clothing, and 
be placed upon alteratives and tonics for a few months to destroy 
the amoeba in the blood. Change the diathesis and build up 
fresh blood. Such alteratives as ozonized saxifraga, compound 
ijdide potassa ; and for tonics, glycerite of ozone, compound 
tincture cinchona and mineral acids. Irritating plaster to nape 
of neck, two points, one inch square each, to stimulate the origin 
of the olfactory nerve in the medulla. One or more thorough 
washings-out of the nasal cavity with the ozonized catarrh 
fluid, ozone et chlorine, will bring away millions of the amoeba, 
and very frequently in itself effects a cure. Still, it is a good plan 
to repeat in three or four weeks. Meantime, if the case is a bad 



DISEASES OF THE ORGANS OF RESPIRATION. 287 

one, the patient could douche out the nostrils every night with 
an infusion of golden seal (tepid), to which some borax is added, 
say a tablespoonful of pulverized golden seal, one teaspoonful 
of borax, half a pint of tepid water. — Mix. Infuse a short 
time, strain carefully, so that there may be no particles, and 
use. 

This, in no case, should supersede the ozone et chlorine or 
catarrh fluid, for that is one of the most reliable of all remedies ; 
for, if the nasal passage is once well washed out with that 
invaluable wash, catarrh in nearly every case disappears. It 
acts like magic in removing immense colonies of the micro- 
organism, the amoeba from the nasal canal, and a return to 
good health is very rapid and permanent. 

OZJENA. 

Chronic inflammation of the internal lining membrane of 
the nostrils, with ulceration down to cartilage, and the devel- 
opment of the disease-germ oidium albicans — common in old 
cases of catarrh, in tubercular and syphilitic cases, and also in 
necrosis and foreign bodies in the nose. 

Symptoms are the same as catarrh — uneasiness, stuffing 
in head, headache ; profuse muco-purulent discharge, often 
tinged with blood, intensely fetid and loaded with disease- 
germ. 

Indeed, the odor is intense, pungent ; formation of flakes of 
hardened mucus and germs; caries or necrosis in broken 
down subjects. 

Treatment. — Same as chronic catarrh — use of nasal douche 
daily, with catarrh fluid every two weeks, and daily either the 
lotion of borax and golden seal, or a solution of permanganate, 
or carbolic acid and tincture of iodine. For the purpose of 
deodorizing the nostrils, the following might be inhaled for a 
minute every two or three hours : 

Iodoform, as much as can be dissolved in ether ; a saturated 
solution, one ounce ; chloroform and alcohol, of each half an 
ounce ; carbolic acid, one drachm. Mix. Use only for inhaling 
at short intervals. If there be any evidence of acquired or 
constitutional syphilis from the long bones or copper-colored 
mucous covering of the arch of the mouth, same treatment as 
for syphilis, not omitting the use of the douche and anti- 
septics. 

The diet is to be generous to a fault, consisting of animal food, 
boiled fish, oatmeal and cream, eggs, fruit and vegetables. As 
alteratives, the saxifraga compound or phytolacca; and as 
tonics, glycerite of ozone, cinchona and a omatic sulphuric 
acid, glycerite of kephaline. 



288 DISEASES OF THE ORGANS OF RESPIRATION. 

INFLUENZA. 

An epidemic disorder, accompanied with all the symptoms 
of catarrh and fever; contagious and infectious. It is, no 
doubt, caused by some meteorological ; electrical condition of 
earth and atmosphere acting on vital forces somewhat depressed. 
Whatever it may be, it is capable of altering the normal living 
matter concerned in the nutrition of the lining membrane of 
nose, fauces and bronchi into the disease-germ amoeba. 

It must enter the blood speedily, because there is great pros- 
tration and debility ; running from eyes and nose, frontal 
headache, cough, restlessness, rigors and a high fever, often 
delirium. 

Symptoms are those of an aggravated type of fever ; the 
rigor is intense ; the pain in head, back and calves of the legs 
is violent; heat very great; respiration and pulse high, 
secretions depraved ; coryza, sneezing, muco, then profuse 
muco-purulent discharge from nose loaded with the disease- 
germ ; fauces inflamed and swollen ; great soreness in throat ; 
hoarseness, harassing cough, with muco-purulent expectora- 
tion ; shortness of breath ; tongue heavily coated ; taste per- 
verted; stomach disordered. In addition to these signs of 
nervous and muscular prostration the case may be compli- 
cated with bronchitis, pneumonia and albuminuria. 

Its duration is short, from one to two weeks, terminating in 
an attack of diarrhoea, or diuresis, or profuse sweating. 

Treatment. — An emetic of lobelia and boneset, followed by 
alcoholic vapor bath and mild cathartics ; patient to kept in bed 
in a warm room with moist atmosphere; aconite, veratrum 
viride and belladonna administered till pulse is down to sev- 
enty ; compound tincture serpentaria to excite diaphoresis ; 
warm demulcent drinks, as flaxseed or marshmallow. Anti- 
septics are the drugs to be relied upon for the breaking up of 
the disease. Carbolic acid and tincture of iodine internally 
every hour as in typhoid fever, same formulae, and the moist- 
ure of the room properly filled with the vapor of the same, 
patting one ounce of each into a small earthen bowl on stove, 
filled with boiling water. If case is bad, or in great urgency 
for relief, hot steam vaporisers should be placed at bedside, 
with antiseptic spray, as permanganate or chlorate potass. If 
prostration be great, careful nutrition, beef extract, eggs, milk, 
quinine. Convalessence should be established upon a well- 
regulated tonic treatment, nutritious diet, country. 

Epizootic Affections in the horse are identical with influ- 
enza in the human being — in causes, symptoms and treat- 
ment, the amoeba in animals being of a large or giant micro- 
organism. But suppose this form peculiar to the horse is 



DISEASES OF THE ORGANS OF RESPIRATION. 289 

communicated to man, we not only have an aggravated form 
of influenza or catarrh, but the giant amoeba brings about 
chronic inflammation of liver, spleen, kidneys, giving us hsem- 
aturia, Blight's disease, leucocythaemia, dropsy and death; so 
that in cases of this kind our best modes of nutrition, our 
most powerful antiseptics and tonics, fail either to destroy the 
germ or maintain vital force. 

Pink Eye is simply a modified form of the epizooty or 
giant amoeba, only affecting the mucous membrane of the eye 
instead of the nose. There is a scarlet redness of the eyes, 
quite considerable swelling, intolerance of light. General 
health is usually bad from overwork, overcrowding, sameness 
of diet, or else poor food, bad ventilation. 

In all such cases an alterative and tonic treatment should be 
maintained for some months, and the very best of diet that 
the circumstances of the patient can afford. 

EPISTAXIS. 

Bleeding from the nose may take place from a variety of 
causes, such as blows, falls, fractures, plethora. It is a com- 
mon symptom of congestion of the brain, as in apoplexy; of 
disease of the heart, liver, kidneys ; present in the early stage 
of fevers, and often due to morbid states of the blood, as scurvy, 
purpura, leucocythsemia ; besides, it often exists or is dependent 
on a special diathesis. 

For the purpose of arresting the haemorrhage, the erect 
posture, holding both arms above the head, the application 
of cold to nape of neck, to cause contraction by stimulating 
the olfactory at its root in the medulla, the removal of all 
articles of dress. If not arrested by the above, cold to nose, a 
cold spray of perchloride of iron or alum in solution, or if no 
atomizer be handy use douche or syringe, plugging the nose 
with cotton saturated with astringents; otherwise general treat- 
ment as to cause. 

Hsematopkilia is a diathesis in which there is a tendency to 
bleed from nose and other parts. It is a hereditary condition, 
supposed to be chiefly transmitted by the mother. Boys 
affected with it rarely live. It visually manifests itself in early 
life, at dentition or puberty ; in females at first appearance of 
the menses and their cessation. All cuts, scratches bleed pro- 
fusely : some races are more liable to it than others; due to a 
defect in fibrin of blood. Nutritious diet, abundance of fresh 
air, use of digitalis with care, with mineral acids and prepara- 
tions of cinchona are supposed to overcome it, but it is very 
doubtful. It is identical with what is termed the haemorrhagic 
diathesis. 

31 



290 DISEASES OF THE ORGANS OP RESPIRATION. 



NASAL POLYPUS. 

This is supposed to originate in some constitutional defect, 
as tuberculse, the exciting cause being some irritation, as 
scratching, pulling hairs, snuff and other irritants. 

There are three varieties, each of which is found protruding 
from the mucous membrane — gelatinous, fibroid, malignant. The 
gelatinous may be slate-colored, like an oyster, or red from an 
excess of blood-vessels, always soft ; the fibroid may be pale or 
red, but hard and compact; the malignant may be either 
medullary or scirrhus ; gelatinous most common. Polypus of 
the nose usually commences from a follicular irritation of the 
pituitary membrane, and gradually enlarges, until it fills up 
one nostril and obstructs the other. It gives rise to headache, 
a stuffing in the head, and an irresistible desire to blow the 
nose, with no relief in doing so ; muco or muco-purulent dis- 
charge; frequent attacks of epistaxis; sense of taste and smell 
greatly diminished, or even lost ; if it presses on the orifice 
of the eustachian tube, dullness of hearing; articulation 
indistinct ; deformity of cheek ; obstruction to tears, and per- 
haps pressure on the brain. If the diathesis is permitted to 
remain, they are prone to return after their removal. 

Treatment. — In all cases enforce a rigid constitutional treat- 
ment, same as laid down under Taberculse, and then select the 
best of the various methods of removal, viz. — excision, ligation, 
torsion, or destruction by caustics. The principal objections 
to excision are, haemorrhage, and a return of the polypus; liga- 
tion and torsion are free from these objections, but oftentimes 
difficult of application, for it is not always we can pass a liga- 
ture round them, and they very rarely admit of being seized 
and twisted. Destruction by caustics is slow but very effectual ; 
various snuffs are used for this purpose, as blood-root finely 
pulverized with sulphate of zinc; blood-root, bayberry, and 
sulphate of zinc, in proportion to age of patient. 

ACUTE LARYNGITIS. 

Acute laryngitis is a rare disease, being confined almost 
exclusively to adult males; women and children almost exempt 
from this form of inflammation. A slight inflammation or 
congestion of the mucous membrane of the larynx is common 
in all ages and in both sexes, as the result of cold, damp, etc.; 
its signs being, soreness or rawness, hoarseness, and a dry, harsh 
cough. But acute laryngitis is a grave, formidable and fatal 
affection, when it occurs in men whose nervous system has been 
shattered by worry, care, struggle for existence, and involves 
the mucous and sub-mucous coats. It is a paltry piece of human 
mechanism that is attacked, perhaps merely the fraction of an 



DISEASES OF THE ORGANS OF RESPIRATION. 291 

inch, but the inflammation is terrible and rapid in its results ; 
congestion first, effusion of plastic lymph obstructing the chink 
of the rima glottis, preventing the ingress of air. The predis- 
posing cause is, depression of the great sympathetic, whose 
branches freely cover the larynx in adult males — the depression 
being some emotion, desire, affection, passion ; the exciting 
cause, exposure, fatigue, wet, poisons. 

Laryngitis, then, being peculiar to persons of a shattered 
nervous system, comes on very insidiously. At the end of a few 
hours, violent rigors, fever of a high grade, fauces red, swollen ; 
pain over the cartilaginous part of the throat; great difficulty 
of breathing and swallowing ; patient very anxious ; hoarseness, 
and complete loss of voice ; spasmodic exacerbations, with par- 
oxysms of threatened suffocation ; long inspirations ; peculiar 
wheezing sound as if air was being drawn through a narrow 
tube ; harsh, brassy cough ; difficulty of swallowing ; liquids 
more difficult to get down than solids, as they bring the circular 
muscular rings into active exercise. Face and neck first flushed, 
then livid, subsequently purple ; eyes protruding ; pulse hard 
and frequent; great distress. Larynx and trachea move rapidly 
upwards and downwards; all the respiratory muscles brought 
into powerful action, so the chest heaves violently. Patient 
grasps at his throat, gasps for breath, gets out of bed, will thrust 
his head out of window. He soon becomes delirious or coma- 
tose, and dies from non-oxygenation of blood. The duration 
of the affection is from forty-eight to seventy-two hours. Almost 
invariably fatal. 

Treatment. — The importance of active treatment cannot be 
too strongly insisted on. Immediate relief is indispensable. Rest 
and quiet; forbid talking. Air of room to be kept at 75° Fahr., 
very moist, with warm vapor. Extract of belladonna in hot 
linseed poultices to throat. Inhalation of warm vapor of tinc- 
ture belladonna and iodine. Diet — cream, raw eggs, extract of 
raw beef. 

Veratrum viride in three-drop doses every twenty minutes ; 
from twenty to thirty grains of sulphate of quinine every two 
or three hours, between which from a quarter to a half grain of 
sulphate of morphia. If necessary, open bowels with beef-tea. 
No debilitating treatment to be used in acute laryngitis — make 
an effort to guide patient over third day and run it into 
chronic laryngitis, from which he will recover. 

CHRONIC LARYNGITIS. 

This is a very common form of laryngitis. Membrane lining 
laryngeal cartilages becomes thickened, ulcerated, also involv- 
ing the fauces and uvula. 

It may be caused by cold, damp, exposure, exertion, inhaling 



292 DISEASES OF THE ORGANS OF RESPIRATION. 

noxious gases, etc., and those conditions intensified by morbid 
states of blood, as tubercular, syphilis, mercury, lead, amoeba 
of catarrh, and want of volition in harmony with exercise of 
vocal cord and larynx in clergymen. The ordinary symptoms 
are, general debility, cough, expectoration, hoarseness, loss of 
voice, with ulceration of the mucous membrane of the larynx, 
fauces. The different varieties are to be recognized by the 
following land-marks : 

Simple Chronic Laryngitis, by soreness, rawness, redness. 

The Syphilitic Form, by its copper-colored appearance, and 
dry huskiness. 

Mercurial Form, by its dingy, metallic hue, and peculiar fcetor 
of breath. 

Tubercular Form, by its mottled appearance and diathesis. 

The profession or avocation of the patient will guide us as to 
the others. Either of the forms may give rise to thickening, 
warty excrescences, and small polypi on different parts of the 
larynx, which aggravate the difficulty, cause impediment to the 
entrance and exit of air, and impairment or loss of voice. The 
sputum of chronic laryngitis is loaded with amoeba, which would 
necessarily cause it to be contagious and infectious. 

Treatment. — General principles must guide us in its differ- 
ent forms. Skin to be attended to by daily baths and friction ; 
bowels to be seen to, clothing to be woolen ; appetite to be stimu- 
lated, and diet to be rich in blood elements and very generous. 
Mouth and throat gargled with a wash of borax, chlorate or 
permanganate of potassa, three times a day. Atomized spray, 
warm vapor once a day, consisting of carbolic acid and tinc- 
ture of iodine, or chlorate of potassa, or some other antiseptic. 
The use of demulcents, as gum-arabic water, elm water, flax- 
seed tea, marshmallow, white of eggs, and common salt are to 
be recommended. Aleratives, as compound syrup of yellow dock, 
ozonized saxifraga, phy tolacca, iodide potassa, and tonics, as cin- 
chona, ozonized glycerine, ozone-water, nux vomica. Tonics 
before meals, alteratives two hours after. Two points of sup- 
puration to be kept active by the irritating plaster on side of 
spine below the nape of neck. 

Special Treatment as to Cause. — Muriate of ammonia in 
the simple form ; iodide potassa, nitric acid and compound tinc- 
ture cinchona, ozonized phytolacca in the syphilitic; ozonized 
glycerine, compound hypophosphite of potassa, tincture iodine 
in the tubercular; iodide of potassa in the mercurial; ozonized 
catarrh fluid, if due to catarrh. If no cause can be ascertained, 
then a general alterative and tonic course should be inculcated 
and carried rigidly out; change of air, of locality, diversity of 
scene, every possible means adopted to build up the general 
health. 



DISEASES OF THE ORGANS OF RESPIRATION. 293 

LARYNGITIS CLERICORUM. 

A form of laryngitis common among a class of clergymen 
and other persons who use their voice in a sing-song or mono- 
tonous way, without the will harmonizing with the act of voli- 
tion. The exercise of any of the voluntas muscles, without 
the will being in unison or harmony with the act, is invariably 
attended with degeneration or disease. 

The vocal cords are made up of a series of fine muscles, abun- 
dantly supplied with nerves from brain, spinal cord and great 
sympathetic, to enable man to express his thoughts. The brain 
gives the stimulant, the nervous energ} r , and thus gives the 
motive power ; but this motive power must be in perfect co-ope- 
ration with their exercise — a will, an intellectual effort Avith 
volition in the delivery of a discourse, if it is duly carried out, 
and all ranting avoided, the vocal cords will improve in their 
vital integrity. 

The symptoms in the early stage are simply hoarseness and 
loss of voice, with no apparent change in the mucous mem- 
brane ; but after a while a follicular degeneration can be detected, 
.with congestion and ulceration of the mucous follicles. 

In some cases it is ushered in with a complete loss of voice; 
in others it originates in a sort of uneasy sensation in the upper 
part of the throat, with an inclination as if there was some- 
thing to swallow ; cough, and the larynx painful on pressure ; 
expectoration of a thin, viscid mucus, occasionally pus, with 
gradual loss of voice or diminution of its power ; hoarseness 
towards evening, which gradually merges into complete apho- 
nia with ulceration, or unhealthy granulations, or even vege- 
tations. As the disease advances, it gradually merges into 
tuberculse, and terminates, if not in recovery, in lung consump- 
tion, caries of cartilages. 

Symptoms are nearly identical with chronic laryngitis, — 
aphonia, cough, and expectoration. 

It is, perhaps, important to diagnose it from syphilitic laryn- 
gitis, which is common among clergymen. A man preaching 
the gospel who is incapable of putting an intellectual effort 
into his words is unfit for his profession. 

Treatment. — Same as for chronic laryngitis, with absolute 
rest of voice. Alteratives and tonics, best of diet, irritating 
plaster to neck, moist atmosphere; inhalation of carbolic acid 
and tincture of iodine; an even temperature, 75° F., and a 
persistent use of special tonics to act on larynx, as aconite, bella- 
donna, nux vomica, quinine, iron, and diluted hydrocyanic 
acid. 

Those invaluable remedies, as compound saxifraga, glycerite 
of ozone, kephaline and cinchona, and aromatic sulphuric acid, 



294 DISEASES OF THE ORGANS OF RESPIRATION. 

must be persistently administered in order to reconstruct the 
shattered part. 

APHONIA. 

Loss of Voice from Functional, Blood or Organic Disease, 
operating upon the vocal cords, varies in degree from a slight 
hoarseness to complete dumbness. There are numerous varieties, 
as aphonia from absence of tongue ; aphasia, the loss of the 
cerebral faculty of speech by disease of the base of brain from 
nitrate of silver, lead, bismuth in hair dyes and cosmetics, and 
disease-germs as syphilis, tuberculse, diphtheria ; aphonia from 
warts, tumors near the glottis ; aphonia from the different forms 
of chronic laryngitis : aphonia from loss of nerve power, as in 
typhoid, and aphonia from irritation reflected, as in teething, 
worms, masturbation. 

It is necessary to describe them all as they are spoken of 
under their respective heads. There are two forms, however, 
that might be enumerated — functional and organic. 

(1.) Functional Variety. — Keflected irritation tells badly 
on the larynx. Children often lose their voice in teething, 
worms and the like ; women who suffer from uterine, ovarian 
or other forms of irritation of the genito-urinary organs suffer 
much and often. The irritation of the clitoris with hyper- 
trophy of that organ causes a wonderful harshness of voice, 
rough and masculine. Males of effeminate type, sensitive dis- 
position, are great victims of aphonia, if addicted to masturba- 
tion. The squeaky voice, with or without loss, is notorious. 
Some men will suffer from aphonia from sexual excess or a 
gonorrhea. If this reflected or functional form is permitted to 
continue long, the vocal cords are liable to suffer atrophy or 
paralysis — become flaccid and powerless. 

(2.) Organic Form. — This is apt to be present in old cases 
of chronic laryngitis, perforating ulceration in the syphilitic or 
mercurial form. It might also follow diphtheria, morbid 
growths, disease of blood and brain. 

Treatment. — This requires great tact and good judgment. 
The removal of causes is of vast importance ; teething, worms, 
irritation of the organs of generation, male and female; the 
destruction of all disease-germs in the blood, appetite pro- 
moted, nourishing diet, shower baths, irritating plaster to nape 
of neck, equable temperature, 75°, moist atmosphere, inhalation 
of warm, atomized sprays of ammonia, tincture of hydrastin, 
gargles of chlorate of potass, bay berry, iodoform. 

General alterative and tonic course of treatment, using freely 
such remedies as ozonized glycerine, compound syrup Phy- 
tolacca ozonized; and as tonics, quinine, iron, hydrastin, nux 
vomica. If the cases do not yield, large doses of bromide of 



DISEASES OF THE ORGANS OF RESPIRATION. 295 

potass, calabar bean, and tincture of green root gelseminum to 
diminish irritation of cerebro-spinal axis. 

CROUP. 

Under this term there are usually classed three different 
morbid states : (1) a spasmodic action of the larynx, usually 
caused by reflex irritation, as teething, worms and derange- 
ments of the digestive organs ; (2) a form of laryngitis, due to 
cold, wet, exposure ; (3) true croup, with the formation of a 
false membrane on tongue, tonsils, uvula, larynx and trachea. 

True Membranous Croup consists of a degradation of nor- 
mal bioplasm into a mycelia, very much resembling the for- 
mation of the oidium albicans of diphtheria, but not conta- 
gious or infectious. It occurs on mucous membrane of air 
passages ; most common during second and third years of life ; 
often complicated with bronchitis or pneumonia. It is very 
apt to terminate fatally from exhaustion, suffocation, convul- 
sions or thrombosis. 

The disease seems to depend on a peculiar cachexia. 

Symptoms in the early stage are very similar to catarrh : 
slight fever, cough, hoarseness, drowsiness, suffusion of eyes 
and running at nose. In the course of a few hours wheezing 
respiration; fits of hoarse coughing; occasional spasm of laryn- 
geal muscles. Then the characteristic symptoms, alteration 
in cough, which has now a peculiar ringing sound, rendering- 
it brassy ; inspirations prolonged, accompanied with a crowing 
or piping noise; redness and swelling of tonsils, uvula, but 
not so diffused as in tonsillitis ; increased fever ; breathing- 
becomes more hurried and impeded ; cough frequent ; great 
prostration, with irregularity of pulse ; great thirst, irritability 
and restlessness ; patient's features expressive of alarm and dis- 
tress; he grasps at his throat, thrusts his fingers into his 
mouth, as if to remove the cause of his suffering; symptoms 
much worse towards afternoon and evening; a remission 
towards morning. If vital force properly aided with remedies, 
overcomes the disease, cough loses its peculiar twang, becomes 
moist, crowing inspirations cease, expectoration takes place. But 
if all fail, and death is approaching, drowsiness becomes great, 
sleep is uneasy, child starts and wakes in terror, breathing 
becomes gasping and interrupted, suffocation seems impend- 
ing, congestion of lungs, skin cold, covered with a clammy 
sweat, asphyxia, coma, convulsions or fatal thrombosis. 

Treatment. — There is much good to be derived from general 
management. Patient must be confined to bed in a room with 
a moist atmosphere, whose temperature is 75° Fahr. ; steam 
atomizer kept running near bed, with antiseptic vapors, iodine, 
chlorate or permanganate of potass ; very nourishing diet ; beef 



296 DISEASES OF THE ORGANS OF RESPIRATION. 

tea, cream, milk and lime-water ; open bowels with enemas ; if 
tongue is coated, emetic ot lobelia ; pack the patient in a blanket 
wrung out of warm water, and cover with three or four 
blankets; aconite and veratrum for fever; belladonna and 
vaseline to throat and neck. In all cases give large doses of 
quinine, from oue to five grains, every four hours ; and every 
half-hour thirty drops of the acetic syrup of blood root, and if 
there are spasmodic contractions of the laryngeal muscles, add 
lobelia. Acetic syrup operates well in the destruction of false 
membrane, and the quinine seems to have a wonderful effect 
on the mycelia in the blood. As soon as the urgent symptoms 
are relieved, remove the belladonna and vaseline from throat, 
and administer tincture belladonna and liquor ammonia ace- 
tatis in closes appropriate to age, but persistently. This will 
meet the condition of embolism; otherwise, case should be 
treated on general principles. 

HOOPING-COUGH. 

An infectious or contagious disease, commonly met with in 
children, and rarely occurring but once in a life-time; attended 
with a slight fever and vomiting, and also, at first, with catarrh, 
and with a peculiar cough that occurs in paroxysms at irregular 
intervals. 

The cause is the presence of the mycelia in the blood — a 
special branch of the oidium albicans family. The field of 
nutrition — the blood, but it has a strong affiinity to localize in 
the cervical portion of spinal cord, in which locality it seems to 
find a pabulum fitted for its nutrition. The blood is heavily 
loaded with both mycelia and bacteria, so that its vital proper- 
ties are seriously damaged. 

Symptoms. — Like numerous other living poisons in the 
blood, it has a period of incubation, or fecundation, growth, 
activity and death, depending a good deal on the vital force 
of the patient, extending from a week to a month, in which 
the ordinary s}miptoms of prostration, with fits of coughing, 
coryza, heat of skin, restlessness and oppression of chest. As 
this stage of incubation passes off the cough assumes a shrill 
sound or whoop ; child instinctively becomes aware, when the 
attacks are approaching, and becomes alarmed; seizures of 
coughs or expiratory efforts very protracted ; suffocation seems 
about to set in, when relief is afforded by a long respiratory 
act, the rush of air through the glottis causing the crowing or 
hooping. During the hoop or spasm there is a strong tendency 
for the diseased blood to coagulate, and thus cause dilatation 
of the heart. 

Immediately after fit patient regains courage ; soon appears 
well. There may be two or three paroxysms in an hour, or 



DISEASES OF THE ORGANS OF RFSPIRATION. 297 

as many in a day. If vomiting occurs after diet there is a 
craving for food immediately afterwards. 

Duration under the old treatment was from a week to three 
months, incubation four to six weeks' active life in germ, the 
same and as long in its death and diminution. Under anti- 
septic treatment, duration about one week or ten days. 

Complications, as measles, small-pox, bronchitis, pneumonia; 
disordered bowels, as cholera infantum, tubercular meningitis, 
always render it fatal ; cough, accompanied with haemorrhage 
from nose, mouth, ears, effusion into the conjunctiva are bad 
complications. It may prove fatal from exhaustion, marasmus, 
convulsions from embolism, or thrombosis in heart or large 
arteries. When disease is permitted to run its course, emphy- 
sema, dilatation of ventricles of heart and glucosuria are 
common. 

Treatment. — Patient should be confined to one room ; every 
whim or desire gratified ; temperature, 70° Fahr.; moist atmos- 
phere ; flannel clothing ; very nutritious but easily digested food, 
milk, cream, fish, eggs, mucilaginous drinks ; attention to bowels ; 
if food is vomited, milk and lime-water or strong coffee. Friction 
to cervical portion of spine night and morning, with bella- 
donna and vaseline. 

Diminish reflex impressibility of medulla and spinal cord 
with the following remedies, put up in fluid extract of sumbul, 
or compound syrup lobelia, or camphor water. To illustrate 
we will select : 

Fluid extract of sumbul or musk root, four ounces ; bromide 
of potassium, one ounce; bromide of ammonia, three drachms; 
bicarbonate potassa, three drachms ; tincture of calabar bean, 
one ounce; tincture of black cohosh, three drachms; tincture 
of belladonna, one drachm; diluted hydrocyanic acid, twenty 
drops. — Mix. From half to one teaspoonful every four hours 
in sweetened water. Between each dose some antiseptic; what 
that will be will depend on the condition of the little sufferer. 
Chlorate or permanganate of potassa answers well if there is 
no looseness of bowels. Carbolic acid and tincture of iodine, 
as laid down under Typhoid Fever, and giyen every hour in tea- 
spoonful doses. 

Internal antiseptics are much better than inhaling vapor of 
tar or the like. 

General treatment by tonics and change of air. 

Other remedies sometimes used, but with poor success. Skunk cab- 
bage, trefolium, capsicum, coffee, droseera, cochineal, nitric acid. 

Bromohydric Acid is useful in some cases, combined with 
quinine, where there is great prostration, and it exercises as 
powerful an influence over acts of reflex origin as the bromide. 
It is well worthy of a trial, especially in those cases accompanied 



298 DISEASES OF THE ORGANS OF CIRCULATION. 

with gastric irritability and vomiting of food. The dose should 
be the maximum for a child. The inhaling of antiseptic fumes 
of tar, gas works and otherwise, not attended with much good, 
but mothers believe it to be beneficial, nay, are superstitious 
of their efficacy. 

ASTHMA. 

An irritation of the nerves that supply the circular muscular 
fibres of the bronchi, causing spasm or contraction. This irri- 
tation may be in the periphery in the bronchi, or in the medulla 
oblongata, so that paroxysms or fits may be induced by reflex 
or direct mechanism, that is to say, the stimulus to contraction 
may be central in the medulla, or it may be in pulmonary or 
gastric portion of the pneumogastric, or in some other part of 
the nervous system, besides the vagus, and being transmitted to 
the medulla by incident, is thence reflected by motor filaments. 

A very good plan is to arrange causes under three divisions : 
(1.) Central causes in the medulla oblongata. (2.) Peripheral 
causes in the bronchi, lung, stomach, heart. (3.) Affections of 
blood. 

(1.) Often hereditary; peculiar types of conformation ; idio- 
pathic. 

(2.) Reflex; disease of heart, stomach, lungs, alimentary canal, 
skin. 

(3.) Germs in blood irritating the weakened cerebral bulb or 
periphery, as tubercle, syphilis, rabies, gout, etc.; so that asthma 
has always at the root of it some central nervous irritation, or 
some peripheral source of it. 

The causes embraced under these, then, are very numerous, 
as diseases of the chest and abdomen, some latent skin disease, 
certain winds, changes in atmosphere, especially dryness, with 
increase of oxygen and diminished electricity; inhalation of 
disease-germs or irritating substances, the micro-organisms of 
plants, flowers, hay, malaria, gout, rheumatism; non-acclimati- 
zation or incompatibility to soil, location or country. If there 
is no apparent cause, blood-germs, as syphilis, rabies, tubercular. 
An asthmatic is thin, of a nervous temperament, round-shoul- 
dered ; countenance expressive of attacks of suffering ; cheeks 
hollow; voice rather hoarse ; slight cough; suffers from nervous 
dyspepsia. 

Symptoms. — Languor, lassitude, debility, headache and 
drowsiness, often digestive derangement; or it may occur sud- 
denly without any of those signs. Most generally the patient 
falls into a sleep, when he suddenly awakes with a sense of 
suffocation or constriction about the chest; smothering and 
difficulty of breathing increases until there is a most fearful 
struggle for breath. Patient gets right up in the sitting pos- 



DISEASES OF THE ORGANS OF RESPIRATION. 299 

ture and assumes various positions to facilitate respiration. 
Chest becomes distended to its utmost limit. The contractions 
of the circular muscular fibres of the bronchi are so great that 
they offer a perfect obstruction to the entrance or exit of air. 
On placing ear to the chest, no natural breathing audible, but 
dry murmurs, loud wheezings, shrill whistlings are heard. 
Pulse becomes small, feeble, almost imperceptible; eyes staring, 
protruding from sockets; countenance anxious; lips purple; 
temperature of body falls to nearly 80° Fahr. But after a while 
of intense suffering, the skin becomes bathed in a copious sweat. 
After that usually the spasm breaks and the patient obtains 
relief. Cough, with some expectoration; paroxysms ceases, and 
patient falls asleep, 

One attack may follow another, or there may be a series of 
light attacks violent enough to keep patient up in his chair to 
midnight. Attacks may come on every night or at long inter- 
vals — often periodical. Asthma is very capricious, kept up by 
some climates, some aromas, gases, houses, beds, etc. During 
the interval or between attacks patient enjoys moderately good 
health. Men are more frequently attacked than women. 

Asthma, denominated hay, ragweed, roses, and the micro- 
organism of plants and trees does not differ in symptoms. The 
bacilli of the vegetable kingdom acts as an irritant to the peri- 
phery of nerves in the bronchi; it is reflected to the bulb and 
transmitted back — hence the spasm. 

The duration of asthma is apt to be tedious if not arrested 
promptly at the start. Its effects or results are, thickening of 
the circular muscular rings, with effused lymph, causing a per- 
manent narrowing of tubes and wheezing respiration ; dilatation 
of the air vessels into sacs or pouches, as in emphysema; dila- 
tation of ventricles of the heart from embolism; general breaking- 
down of the nervous system, nervous dyspepsia, alkaline dia- 
thesis, etc., etc. 

Treatment. — During the attack, if the stomach is loaded, 
an emetic of lobelia; or if suffering from constipation, copious 
enemas. Then the great object in treatment is to relax bronchial 
spasm. For this purpose some of the following remedies should 
be tried, selecting one until one is procured that is effectual. 

Lobelia, useful in a number of cases; when it produces nau- 
sea and collapse the attack often ceases. Compound powder is 
best form. 

A cup of strong coffee will often ward off an attack ; so will 
a strong glass of hot whisky punch. 

Inhalation of chloroform or other anaesthetics, like ether, are 
of little utility. Iodoform dissolved in ether and inhaled may 
be useful if due to catarrh. 

A dose of two grains of iodide of potassa, the same of car- 



300 DISEASES OF THE ORGANS OF CIRCULATION. 

bonate of ammonia, with twenty drops of tincture of bella- 
donna, may ward off an attack. 

Nitrite of amyl, five drops on a cloth and inhaled, or iodide 
of ethyl, six to ten drops, inhaled; either one increases the 
bronchial secretion, gives instant relief. Their effects are tran- 
sient but often curative. Nitrite of amyl in alcohol operates 
like a charm, as follows: alcohol, half an ounce; water, one 
ounce and a half; nitrite amyl, three drops. — Mix. Add to 
half a tumbler of ice or cold water and drink at once. The 
alcohol keeps up the action of the nitrite of amyl for some 
time. Such a combination relaxes the arterial vessels to their 
minutest subdivision, relaxes organic muscular fibre. 

One or more drops of a one per cent, solution of nitro-gly- 
cerine produces, within a few minutes, a diminution of tension 
and wonderful relief in breathing. Its effects are marked and 
durable. 

The fluid extract of quebracho is used most successfully in 
asthma. A teaspoonful, repeated every ten minutes, relieves 
the difficulty of breathing. 

Members of the medical profession are disgusted with the 
endless complications and combinations of antispasmodics, and 
have sought other remedies, as jaborandi and its alkaloid, pi- 
locarpin. The powerful revolution which that remedy produces 
in the distribution of the blood, has a most beneficial effect in 
asthma, attracting the blood to the skin and salivary glands, 
and by diminishing its volume through the copious perspira- 
tion and salivation. The interstitial changes in the lung after 
its exhibition is followed by amelioration of all the symptioms. 
Its use requires care and caution. The alkaloid, by hypodermic 
injection, is preferable to the fluid extract, in doses of about one- 
third of a grain. During the action of drug, recumbent 
posture. 

Antispasmodic fumes may be used in the absence of better 
remedies; they owe their properties chiefly to ammonia, or 
some acro-narcotic, nitre paper, stramonium, belladonna and 
lobelia; cigarettes produce when inhaled intense hyperemia, 
as may be seen in the buccal, pharyngeal, laryngeal mucous 
membrane of habitual smokers, and exudation which tends to 
soften and detach obstinate mucus. With such remedies, we 
endeavor to overcome spasm ; and with the use of the bromine 
compound as laid down under hooping-cough, in doses of a 
teaspoonful every three hours, we make an effort to ward off 
attacks, and in the interval we try curative measures. 

Curative Treatment. — Great care and diligence to ascertain 
cause or causes. If there seems to be a catarrhal condition, 
treatment as laid down under that head — if there are latent 
germs present in the blood treat accordinly. Dogs licking 



DISEASES OF THE ORGANS OF RESPIRATION. 301 

children's hands, in whose mouths the germ of rabies are often 
present, is a fruitful but unthought of cause of asthma in adult 
life. Powerful alteratives, as iodide of potass and ozonized 
glycerine ; indeed, these constitute the most certain way of curing- 
asthma, whatever its origin may be. Blisters or irritating plas- 
ters to nape of neck on both sides, an open sore. If there are 
any reflex conditions, remove them. If digestion is weak. 
cinchona compound and mineral acids, pepsine, gentian. If 
there is evidence of malaria, tincture iodine, green-root, tincture 
of gelsemine with quinine. If no cause can be discovered, a 
general alterative and tonic course. 

Rosin-weed and a large list of worthless drugs are now dis- 
carded in the cure of asthma. 

Every possible means taken to improve the general health 
by tonics; the most nutritive diet, regular mode of life; daily 
use of the cold shower or sponge bath; removal of dyspepsia: 
meals to be taken at such hours that digestion may be com- 
pleted before retiring to bed. Flannel clothing. To sleep on 
hair or straw mattress, bed in all cases to be insulated from the 
floor or wall by glass castors, so as not to permit his electrical 
forces to be drawn off. A suitable house, location or climate 
selected. 

As to the effects of asthma, thickening of the rings of the 
bronchi, alteratives, irritating plaster are of great utility: other 
terminations managed on general principles. 

EMPHYSEMA. 

A pouch "or air-sac in the lungs. Two varieties : Vesicular 
and inter-lobular emphysema. 

Vesicular Emphysema. — Consists of a debilitation, enlarge- 
ment, and coalescence of air-cells, atrophy of their walls, and 
obliteration of their vessels, may affect one or both lungs, or a 
part of each, especially anterior edges and aprices. 

Its causes are degeneration, a sort of interstitial death, des- 
troying elasticity and contractility of affected tissues, the 
air-cells and their surroundings, which conditions may be 
caused or intensified by running, jumping, hoisting, playing 
base-ball or wind-instruments, singing, shouting, lifting, dig^ 
ging, rowing, running up stairs, or by anything that would 
cause the patient to take prolonged deep inspirations, or sud- 
den check to an expiration, a sequel of hooping-cough, asthma, 
chronic bronchitis. 

Inter-Lobular. — Consists of an infiltration of air into the 
inter-lobular areolar tissue, or into sub-pleural areolar tissue. 
This form is generally caused by rupture of the air-cells by 
violent strain, or fractured ribs, and is generally met at the 
corners or abrupt angles of the lungs. The destruction is im- 



302 DISEASES OF THE ORGANS OF RESPIRATION. 

portant, as the form is very hopeless, and can only be relieved 
by antispasmodics. 

Symptoms. — The symptoms are the same in both forms. 
General debility, with shortness of breath and difficulty of 
breathing, increased by slightest exertion, and general distress, 
that the sufferer is unfit for any active occupation; feeble 
cough, expectoration of frothy sputa, dusky appearance of 
countenance, weakness of voice, stooping gait; loss of flesh and 
strength, lowered temperature, 85° Fahr.; very weak and slow 
pulse, 50 to 60; respiration 12 per minute; constipation, occa- 
sional paroxysms of asthma; chest barrel-shaped, scarcely any 
movement of the intercostal muscles in breathing ; on percus- 
sion, an unnatural clearness tympantis can be mapped out, and 
to be found there at all times. Auscultation reveals indication 
of vesicular murmurs as must rule us in bronchitis. Heart 
sounds are very feeble, and that organ is frequently displaced. 
Disease of the right cavities of heart, with venous congestion 
and dropsy. Diseased side bulging, round or prominent in 
bad cases. 

Treatment. — Emphysema is generally regarded as an incur- 
able affection, and that is correct in a large proportion of cases ; 
still there are few cases that does not admit of much ameliora- 
tion, and very many of the vesicular form curable. 

All conditions that would be likely to cause sudden inspira- 
tion or expiration should be avoided, as mental and physical 
excitement, no shouting nor attempts at running, lifting, row- 
ing, etc. Warm flannel clothing, very generous and strength- 
ening diet, and tonics to stimulate appetite. Some remedies 
have a remarkable power over the interstitial tissue and stroma 
of the lungs in atrophy or in sclerosis, such as lobelia, quinine 
and hyosciamus ; one grain of each thrice daily operates well, 
and effects some good cures put up in pill form ; liquor ammonia, 
sumbul, phosphate of iron and quinine, also, are of great effi- 
cacy. The lobelia, quinine and hyosciamus pill is our best 
combination ; next, bromohydric acid ; warm, moist atmosphere. 

DIFFICULTY OF BREATHING. 

Difficult respiration may be due to a variety of causes, viz. : 

Pharyngeal, from inflammatory swelling of fauces, tonsils. 

Laryngeal, in croup, laryngitis, syphilitic tubercular and 
cancerous disease, foreign bodies, growths, spasms, paralysis, 
tumors, aneurism. 

Tracheal, ulceration, narrowing or pressure. 

Pulmonic, as bronchitis, asthma, emphysema, consolidated 
effusion into lungs, chest. 

Heart, in valvular disease, obstruction to the return of blood 
from pulmonary veins. 



DISEASES OF THE ORGANS OF RESPIRATION*. 303 

Other cases, as spasm of chest and diaphragm in tetanus, 
trichinosis, pressure on diaphragm by water in the cavity of 
abdomen, ovarium tumor, gravid uterus. 

Snoring or Stertorous Breathing. — Many valuable lives 
are daily lost by inattention to the character of the breathing. 
Physicians, in grave states of peritonitis, gastritis, nutritis, etc., 
induce narcotism as a means of stamping out the disease in 
which stertorous breathing is an essential symptom, and when 
this end has been gained the patient is permitted to die, simply 
because the position is not changed. We might enumerate 
other diseases, as pneumonia, etc. It should be always borne 
in mind that stertorous breathing is a pure mechanical con- 
dition, and can be got rid of. There are, so to speak, three 
forms of it : 

1. Nasal or Palatine Stertor, when the air is rushing through 
the nose or mouth, causing a vibration of the soft palate. 

2. Pharyngeal Stertor, when the air passes through the nar- 
rowed interval between the base of the tongue and the pos- 
terior wall of the pharynx. 

3. Mucus Stertor, when there is mucus in the air tubes, and 
the air in breathing bubbles through it. 

Of these three, pharyngeal stertor is the most common in 
apoplexy, fracture of skull, chloroform, and intoxication from 
alcohol and narcotics. 

Mucus stertor, when unaccompanied or unconnected by living 
engorgement, may occur in serious cases, when the nutritive 
process of the lungs are interfered with by some injury to the 
seat of life in the medulla oblongata, injuries to the brain, 
convulsions, poisoning with opium, drowning, epilepsy, apo- 
plexy, and the so-called death rattles of profound prostration, 
whether there be fluids in the bronchi or not. Snoring in 
these and other states shows that there is an impedient to the 
ingress of air, so that the blood and tissues fail to be oxygen- 
ized — a condition of non-aeration of blood and embolism ; a 
failure of the heart's action and death. It is very doubtful 
whether a large percentage of death does not really occur from 
this cause, and most of those mysterious deaths that occur 
during sleep. When snoring or stertor forms a symptom it 
should be treated by placing the patient on either side, and 
keeping him there. " This seldom fails to give instant relief to 
this distressing and dangerous symptom with its consequences, 
and death in many cases can often be obviated. 

COUGH. 

A symptom of numerous and various diseases, as catarrh, 
laryngitis, asthma, croup, pleurisy, pneumonia, etc. 

Cough consists in deep inspiration, closure of the glottis, and 



o(J4 DISEASES OF THE ORGANS OF RESPIRATION. 

violent expiratory effort by which the glottis is forcibly opened 
by the compressed air, which carries with it, in its exit, mucus 
or other matters which may have lodged in the lungs or respira- 
tory passages. The nervous centre for this act lies in the me- 
dulla oblongata. It is to be lateral, and situated on each side 
of the central raphe. It is excited into action reflexly by irri- 
tation of the respiratory branches of the vagus, distributed to 
the folds of the epiglottis, to the whole interior of the larynx, 
to the trachea, especially at its bifurcation, to the bronchi, to 
the substance of the lung itself, as well as the pleura when it 
is inflamed. Irritation of the internal auditory canal at the 
point to which the auricular branches of the vagus are dis- 
tributed, also causes coughing; and so may irritation of stomach, 
liver, spleen. As coughing is a reflex act, excited by irritation 
applied to a sensory nerve, and reacting through a nerve- 
centre upon the respiratory muscles, it is obvious that it may 
be lessened either by removing the source of the irritation, or 
by diminishing the excitability of the nervous mechanism 
through which it acts. Both medicines are employed in prac- 
cine. One of the most common being to lessen irritation by 
the use of mucilaginous, or saccharine, or oleaginous substances 
which have no action upon the nerve-centres; the other by 
acting on the nerve-centres. 

The probable action of marshm allow, gum liquorice, is to 
soothe irritation at the root of the tongue, around the fauces, 
as well as the trachea, bronchi or lungs. This probable action 
in relieving cough depends to a great extent on their muci- 
laginous coat. Sedatives relieve cough by entering the blood, 
and being carried to the medulla lessen the excitability of 
the nerve-centres, such as bromohydric acid with spirits of 
chloroform and syrup squills, or a mixture of solution of 
hydrochlorate of morphia; dilute hydrocj^anic acid, of each, 
twenty drops ; glycerine and infusion of gentian, of each, two 
ounces; chloroform, three drachms. A teaspoonful, as indi- 
cated, every three hours. Muriate of ammonia, etc. 

Cough, from teething and intestinal irritation, lancing gums, 
emetic wine of ipecac, etc. 

Cough, from relaxed or elongated uvula, over-large tonsils, 
alteratives, iodide, iodoform, excision of uvula. 

Ear-cough, due to disease of the ear. 

Nervous and hysterical cough. Sumbul, lobelia, pulsatella, 
bromine, horseback exercise, sea bathing, shower baths, nour- 
ishing food. 

BRONCHITIS. 

Inflammation or partial death of the mucous membrane of 
the bronchial tubes. It may be acute or chronic, and affect the 



DISEASES OF THE ORGANS OF RESPIRATION. 305 

larger or smaller tubes or both; or one or both lungs through- 
out, or only a portion of them. 

Acute Bronchitis, — A very dangerous form of inflamma- 
tion, accompanied with great fever and prostration, and danger 
of a spread of the inflammation to the vesicular texture of the 
lungs, or a plugging up of the bronchi with effused lymph and 
collapse, or inflammation of the substance of the lung with 
blood, lymph, liquor sanguinis, etc. 

The causes are usually cold, damp, wet, exposure to vicissi- 
tudes of weather, inhalation of irritants, etc., etc. 

Symptoms. — Shock, with indications of prostration, violent 
headache, with rigors and a high grade of fever; pulse often 
one hundred and forty; respirations from thirty to forty; heat 
105° up; a sense of intense soreness or rawness over the affected 
part; tightness or constriction of the chest; hurried or excited 
respiration, with rough wheezing; incessant hacking, dry cough 
at first, afterwards expectoration of viscid, glary, frothy mucus, 
and afterwards of muco-purulent matter; pulse, although fre- 
quent, is weak; tongue heavily coated, nausea, great anxiety, 
with indications of prostration and collapse. 

Inflammation of the main trunk or large sized tubes is 
attended with much less danger than the smaller branches. In 
the smaller branches, there is a greater tendency, in a fit of 
coughing or excitement, for the tube or tubes to be blocked up 
by thick, viscid, tenacious phlegm, which, on taking a deep 
inspiration, is liable to be pushed down ; acting as a cork, pre- 
venting the air from reaching a lobe of the lung, hence collapse. 
A portion of lung not filled by air becomes quickly hepatized 
or vesicular, emphysema is produced ; so that in either case we 
have a vital organ incapable of aeration. 

On percussion of the chest in bronchitis, the lungs should 
exhibit resonance and clearness from top to bottom ; at least, 
no marked alteration should be detected, with the exception of 
increased resonance in emphysema, or the dull, flat sound of 
hepatization in collapse. 

On auscultation, in the early stages, dry sounds or rales can 
be distinctly heard, like air rushing through a red hot tube. 
If heard over the main trunk or large branches, it is called 
rhonchus; if over the small branches, sibilus, Rhonchus to the 
large, sibilus to the small. Sibilus bespeaks danger ; rhonchus 
almost free from it. These dry sounds are usually only heard 
the first few days, for once the inflammation has terminated in 
effusion and its products have poured out from the inflamed 
membrane, those dry sounds are displaced by moist sounds, 
called large crepitation, if over the large tubes ; small crepita- 
tion if over the small. So rhonchus and large crepitation are 

32 



306 DISEASES OF THE ORGANS OF RESPIRATION. 

the dry and moist sounds of large air passages; sibilus and 
small crepitation of the smaller branches. Its duration, under 
good treatment, should not take over a few days 

Treatment. — Recumbent posture in bed, temperature, 70° 
Fahr., air to be moistened by hot steam. If stomach is badly 
deranged and tongue foul, a gentle emetic of lobelia ; if there 
be constipation, open bowels quickly with enemas and salines. 
Diet to consist of warm beef tea, warm gruel, or warm milk 
and arrow-root, warm mucilaginous drinks, as flaxseed tea, wine 
whey; heat to feet. Mustard is to be applied over chest and 
bac v , large plasters, followed with hot poultices of flaxseed 
meal and glycerine. 

There are several methods of breaking up the attack. If 
seen early, one is by the administration of large doses of tinc- 
tures of aconite and veratrum every half hour, till pulse is 
seventy, and then at less frequent intervals. This is a good plan. 
Another is to give small doses of lobelia until the patient 
becomes slightly nauseated and pulse down, and then at less 
frequent intervals. And a third good expedient is to use jabo- 
randi or its alkaloid ; the former in fluid extract, or, if the latter, 
by hypodermic injection. If jaborandi or pilocarpin be used, 
the patient must cease drinking and spit out his saliva freely. 
The powerful revolution which this latter remedy produces in 
the distribution of the blood, has an instantaneous effect in 
attracting the blood to the skin, relieving the bronchial mucous 
membrane. Its action is quick in giving relief; besides, it 
favors the expulsion of the obstructing plug in the air passages, 
prevents the formation of viscid mucus, prevents the swelling 
of the large bronchial glands and initiates a reparatory process 
in the bronchial tract. In an urgent case the three methods 
might be combined. As soon as the urgent symptoms are per- 
fectly controlled, an alkali, such as the muriate of ammonia or 
chlorate of potassa, or carbonate of ammonia or potassa. The 
effects of alkalies are very marked, indeed. They soothe, soften 
and aid expectoration, and if given in combination with an 
acid, the dry rales subside and are replaced by moist ones ; 
expectoration copious, and cough less frequent aud less trouble- 
some. Convalescence to be established upon alteratives, as the 
ozonized glycerine, phytolacca, and tonics, like quinine and 
mineral acids. 

Chronic Bronchitis — May be a sequel of an acute attack, 
or it may come on of itself from the same causes that produce 
the acute. 

Symptoms. — General symptoms of nervous prostration, lan- 
guor, lassitude, debility; face white, features sharp-pointed; 
nervous dyspepsia ; phosphates and chlorides in urine; great 
emaciation, harrassing cough, even habitual ; great difficulty 



DISEASES OF THE ORGANS OF RESPIRATION. 307 

of breathing, shortness of breathing; sometimes a sense of sore- 
ness or rawness, in other cases this is absent. The lungs in 
ordinary cases should be clear from top to bottom, but as it 
generally assumes one or other of two forms, this may not be 
the case. One form, without expectoration, tends to emphy- 
sema; the other, with copious expectoration, leads to pulmonary 
consolidation. The former will have unusual resonance on 
percussion; the latter, dullness. If there is expectoration, it 
is copious, and aggravated by exposure to cold or damp, bad 
living or change of temperature. There is little rhonchus or 
sibilus in chronic bronchitis, but abundance of moist crepita- 
tion, large and small. In all cases the nutritive disturbance 
proceeds from the surface of the bronchi and gradually spreads 
to the stroma of the lungs, terminating in atrophy or in scle- 
rosis. Dilatation of bronchi, with condensation of surrounding 
tissue, often results ; sometimes a sort of bronchial catarrh, with 
excessive muco-purulent discharge. The winter coughs or colds, 
recurring annually, are but the precursors of more permanent 
forms of bronchial inflammation. When interstitial substance 
of lung is greatly affected in either form, non-seration of blood 
to a limited extent, which gives rises to a blueness of nails or 
lips, slate or even livid appearance of skin, especially of the 
lower extremities. It is essentially a chronic affection, lasting 
years, seldom directly fatal, but may be so by the causing of 
other diseases. 

In chronic bronchitis there is always a true ulceration of the 
bronchial mucous membrane, and a degradation of the living 
matter concerned in its nutrition into the disease-germ, amoeba, 
which is found in great abundance in the sputum ; not, how- 
ever in such immense quantities as in catarrh, still, enough to 
place chronic bronchitis as a somewhat contagious disease. 

Treatment. — This is varied, but embraces certain well-de- 
fined principles. A warm, moist atmosphere, which contains a 
small amount of oxygen, is the most suitable ; flannel or silk 
clothing, especially next to skin; daily bathing, alkaline or 
acid, followed by inunction of warm olive oil to the amount of 
three or four ounces ; diet and drink to be warm and of the 
most nourishing kind, such as milk, eggs, boiled fish, broiled 
tenderloin steak, with abundance of cooked vegetables. Warm 
food and drink are powerful expectorants, and in all cases it is 
well to have the patient drink a cup of hot coffee or milk 
before getting up, or warm beef tea. Stomach to be looked to 
with tonics and bowels carefully regulated. All physical and 
mental exertion or excitement to be guarded against. On the 
front and back of chest there is no liniment or stimulant that 
can equal the irritating plaster. It should be worn as much 
as possible, at least one-half the time. 



308 DISEASES OF THE ORGANS OF RESPIRATION. 

As it is a chronic disease, there should be a persistent course 
of alteratives and tonics, changing them weekly; the tonics 
before meals, alteratives two hours after. Such alteratives as 
ozonized glycerine, compound syrup phytolacca, ozonized saxi- 
fraga, with iodide of potassa, and tonics, ozone-water, solution 
of quinine, tincture cinchona, compound golden seal. 

Besides the above there must be a treatment with expecto- 
rants and bronchial stimulants, so as to arrest or mitigate cough, 
and promote a healing process in the bronchi. For this pur- 
pose various preparations of ammonia are expectorants, such 
as muriate of ammonia in syrup of squills, carbonate or citrate 
of ammonia in syrup senega; chloride or bromide of ammonia 
in syrup of ipecac; nitric acid and compound tincture cin- 
chona; tolu, conium and belladonna; balsam capaiba dropped 
on sugar; cubebs and extract horse-radish; benzoate of am- 
monia in port wine; lobelia and blood-root. 

It is impossible to mention a single remedy ; which ever affords 
the greatest relief should have the preference. 

Besides the above, the greatest benefit is to be derived from 
the inhalation of moist, warm medicated antiseptic vapors sev- 
eral times a day. The remedies to be of any utility must be 
antiseptic; such as sulphurous acid, creosote, cholorate or per- 
manganate of potassa ; tincture of benzoin, benzoate of soda, 
boracic acid, carbolic acid, and a variety of others. The inhal- 
ation of stimulating antiseptics prove very beneficial in all 
cases, and is one of our valuable aids in cure. The action of a 
disinfectant and stimulant on the ulcerated surface, and its 
destructive influence on the germs, is of great benefit ; and one 
thing can be said of it — that it in no way interferes with the 
use of constitutional and internal remedies. It is best to be 
used frequently, for half an hour or more at a time, and as often 
as four or five times a day, and in no case must either its use 
or strength excite any cough. 

Alteratives, tonics, inhalation, and a very free use of expect- 
orants, is undoubtedly the best method of treatment in patients 
under forty-five years of age. When chronic bronchitis occurs 
over that the use of expectorants are of doubtful effiacy, often 
injurious. 

Bronchitis Senilis is a peculiar and dangerous form of 
chronic bronchitis, occurring in persons over forty-five, or in 
the aged, and is due to natural decay or degeneration of the 
bronchial mucous membrane, as a result of age. It is spoken 
of under various names, as catarrhus senilis, bronchitis of the 
old. It seems at first to consist of a general inflammation of 
the capillaries of the tubes, followed by atrophy and interstitial 
death ; sometimes comes on in an acute form, attended with 
great danger ; more generally it is insidious, making its appear- 



DISEASES OF THE ORGANS OF RESPIRATION. 309 

ance with great difficulty of breathing, and excessive secretion 
of frothy mucus. Its symptoms and treatment are the same 
as chronic bronchitis, with the exception .that, as a general rule, 
expectorants operate badly, aggravating the symptoms; whereas, 
under tannin or vegetable astringents there is a remarkable 
amelioration. 

Infantile Bronchitis consists usually in acute catarrh, laryn- 
gitis, bronchitis, general and capillary. It is usually due to 
cold, and is easily recognized by its tendency to asphyxia, 
difficulty of breathing, great congestion of the skin, perpetual 
cough, general restlessness, increasing prostration, and in fatal 
cases, somnolence, muttering, delirium, coma. 

General management as to warm, moist atmosphere, warm 
bath, oil to chest and throat, aconite and belladonna for fever, 
and a free use of lobelia are our best remedies. One heaped 
teaspoonful of pulverized green lobelia, and the same quantity 
of carbonate of potassa to a teacupful of boiling water, allowing 
it to cool and settle ; and begin by administering half a tea- 
spoonful every hour, half hour, or less frequent, giving it 
largely morning and night to procure free vomiting. The 
vertical position of a child's stomach during the early years 
enable it to vomit easily ; and this act is indispensable in 
children, because they swallow the products of inflammation, 
lymph, muco-purulent matter, etc., which, in themselves, tend 
to aggravate the symptoms and keep up a sort of hectic fever. 
There are no remedies so useful in infantile bronchitis as 
lobelia and potassa ; the latter softens, while the former keeps 
up free expectoration. 

As the case improves, ipecac, tolu, senega, squills, wild 
cherry, etc. 

Plastic Bronchitis. — This is simply a form of chronic bron- 
chitis, in which there is a drying up of the lymph and muco- 
purulent matter in the tubes, in which they become solid in 
the shape of the tubes, tubular concretions of exudative matter 
within bronchi. 

Symptoms are the same as the chronic, to which are to be 
added expectoration of casts of tubes, or of moulds of notable 
size, preceded by a great difficulty of breathing, dry, hacking, 
racking cough, followed by haemorrhage, and the haemoptysis 
often excessive. Small casts are expelled easily, while large 
ones, especially if fibrinous, are not easily got rid of, as they 
are congealed and adherent, sometimes a pure congelation of 
lymph or blood. Such bodies, by their irritation, often give 
rise to renewed irritation. It is even more troublesome and 
intractable than the chronic form. 

Treatment, same as for chronic, with the exception that 
such itmedies as carbonate of potassa, chlorate of potassa, 



310 DISEASES OF THE ORGANS OF RESPIRATION. 

muriate of ammonia, iodide and bicarbonate of potass should 
be given more freely and repeatedly ; haemorrhage arrested 
with digitalis in preference to gallic acid or iron. 

Mechanical Bronchitis. — Usually chronic, and due to the 
inhalation of particles which irritate, inflame and ulcerate 
bronchi. For example : file-makers, knife-grinders, carpet- 
shakers, dust of coal in miners, cotton, woollen and silk opera- 
tives in factories, and other occupations. It is customary to so 
designate the bronchitis. 

Secondary Bronchitis. — Chronic bronchitis occurring when 
there are disease-germs or morbid states of blood; germs are 
apt to colonize in the weakened, ulcerated mucous membrane 
of the bronchi, and greatly aggravate the difficulty. We have 
the vibrios of typhoid fever irritating a feeble bronchial tract; 
the latent germ of rabies, the germs of syphilis, tuberculse, etc., 
gout, rheumatism, and other blood-poisons. According to the 
germ or poison present, the bronchitis is so named. The symp- 
toms are much worse, usually double, especially the emaciation 
or wasting debility is very great; night-sweats, copious or exces- 
sive muco-purulent expectoration. Alteratives and tonics, same 
as Chronic Bronchitis, and special drugs to destroy germ or 
neutralize blood-poison in each individual case. 

Hay Bronchitis. — Hay fever, summer catarrh ; often severe, 
with asthmatic symptoms superadded ; due to the micro-organ- 
isms of plants, or bacilli of hay and other grasses, causing a 
degradation of the normal bioplasm of the respiratory mucous 
tract from nose down to the air-vessels. 

Symptoms. — Are quite complicated; headache, suffusion of 
eyes, sneezing, irritation of nose, fauces; larynx, bronchi, often 
greatly congested ; cough, and the other physical signs of acute 
bronchitis. It is a sort of combination of acute catarrh, with 
sub-acute laryngitis and bronchitis. 

Treatment. — Removal of cause if possible. Quinine is the 
best preventative. If chiefly catarrhal, a solution of borax in 
infusion of golden seal with nasal douche. Some of the follow- 
ing remedies to give relief — comp. lobelia, ammonia in some 
form, citrate of caffiene, belladonna, etc. If they fail, general 
treatment for Chronic Bronchitis. 

PNEUMONIA. 

Inflammation of the substance of the lungs. The predis- 
posing cause is intense nervous depression, especially of the 
great sympathetic, debility, exhaustion. The exciting causes 
are cold, damp, exposure, vicissitudes of heat and cold, wet, 
inhalation of irritants, or mechanical violence. 

The usual point of attack is the lower lobe of the right lung, 
which has a large serating surface, and is profusely covered with 



DISEASES OF THE ORGANS OF RESPIRATION. 311 

branches of the sympathetic nerve. Inflammatory action may 
be limited there, or it may extend over to the left, and be forced 
upwards in both lungs. As a rule, with few exceptions, inflam- 
mation proceeds from below upwards. 

Pneumonia is met with in the following forms : Acute, sud- 
den in its seizure, and attended with fever; sub-acute, of the same 
character, but the vital forces of the patient being vigorous, 
resists the local irritation, consequently there is no fever; or 
chronic, which may be a sequel of either of the former, or come 
on of itself from slight irritation in patients whose constitutions 
are feeble. It is called lobular, when confined to one lobe ; 
single, when confined to one lung; double, when both lungs are 
involved; pleural, when the violence comes from without and 
proceeds inward, affecting the pleura first, then the lungs ; and 
typhoid pneumonia, when the powers of life are low, and the 
typhoid germ is developed, giving us inflammation of lungs 
with typhoid fever. 

A case that is permitted to run its course has three distinct 
stages, viz. — congestion, red hepatization and gray hepatiza- 
tion. 

General Spmptoms in First Stage. — Great nervous prostration, 
with pain in the head, back, calves of the legs, with cough, 
shortness of breath, rusty sputum, or streaks of blood, or haem- 
orrhage, restlessness and anxiety, violent rigors and high grade 
of fever, with aggravation of symptoms; pulse 140 to 160, heat 
105° Fahr., respiration 40; flush on cheek or cheeks, nostrils 
dilated, tongue coats heavily with a brown coat, nausea, great 
thirst, loss of appetite. Cough becomes worse, sputum viscid 
and bloody, pain in the affected lung, with frequent but dis- 
tressed breathing, skin has a dry pungent heat, sometimes 
delirium. 

As this is the stage of filling up or engorgement, the affected 
lung which was clear and resonant, gradually becomes dull on 
percussion, and crepitation to a variable extent is distinctly 
heard. If the pleura is involved, friction sounds can be detected ; 
there is exudation into the air-cells and proliferation of their 
lining epithelium. This stage may last a few hours to a week 
or longer. 

General Symptoms in Second Stage. — If the inflammation pro- 
ceed, it passes into the stage of red hepatization, in which all 
the symptoms of the first stage are still present and more 
decided; there is in addition likely to be blueness or lividity of 
the skin, delirium or coma from non-aeration of blood. The 
air-cells are choked by coagulated exhudation of blood and 
lymph; the spongy character of the lung is quite lost, and it 
becomes solid as a liver, neither minute crepitation nor vesic- 
ular murmur can be heard. There is perfect dullness on per- 



312 DISEASES OF THE ORGANS OF CIRCULATION. 

cussion and no intercostal movement; bronchial or tubular 
breathing, with vocal vibration communicated to the walls of 
the chest by the solidified lung and felt by the hand over the 
ribs unless there be water in the cavity of the chest. The du- 
ration of this stage is from a week to a longer period. 

General Symptoms in the Third Stage. — If the inflammation 
still progresses, and the patient does not die in the second stage, 
then the third or grey hepatization supervenes ; then we have a 
complete change of symptoms. Fever abates ; heat, pulse and 
respirations often low ; rigors ; profuse coliquative sweats are 
common ; the flush on cheeks and other physical signs disappear, 
and it looks as if amelioration was taking place ; whereas, we 
have the grave process of suppuration of the substance of the 
lung; diffuse suppuration of pulmonary tissue, with parts 
remaining dense and impermeable ; it is hard to drag through 
with incessant cough ; thick, ropy, tenacious pus. In some cases 
the pus liquifies, and is expectorated, air begins to re-enter the 
affected lung, and resonance and a healthy vesicular murmur is 
restored. Often cases will, during the first and second stage, take 
on a typhoid condition. The tongue will become of a buff leather 
appearance, very dry and parchy, or it may become red, like a 
piece of raw beef, or simply red at tip and edges, with eleva- 
tion of papillae ; the character of the pulse changes to small, 
wiry and frequent ; bowels generally in pneumonia are con- 
stipated, but when typhoid symptoms threaten, diarrhoea, sordes 
on the gums, petechia on skin, eyes sunken, nostrils pinched, 
face white, gurgling in right iliac, and tympanitic state of the 
abdomen. 

No definite rule can be laid down as to its duration. About 
two-thirds of cases run thus : a week of infiltration or filling up, 
a second week in perfect consolidation, and a third in grey 
hepatization, which terminates in suppuration, extending over 
a period of months. 

In any of its stages it is easily recognized ; in the early stage 
its history, flush on cheek or cheeks, the rapid mal-assimila- 
tion, the anxiety or distress, the cough, difficulty of breathing, 
the rusty sputum or blood, pain in side, dullness on percussion 
at base of lung proceeding up, lack of intercostal movement, 
tubular breathing, rigors, fever, purple or livid appearance of 
skin, delirum, coma, etc. 

As a very vital organ is smitten, pneumonia must be regarded 
as a grave affection, if it has passed the first stage ; imperfect 
oxygenation of the blood gives rise to so many complications ; 
besides, delirium, coma and lividity of the lips, nose, hands, 
face, as embolism in brain and heart, that render all cases^very 
dangerous, and our prognosis must be guarded. 

Treatment. — Perfect rest in bed in a room whose atmos- 



DISEASES OF THE ORGANS OF RESPIRATION. 313 

phere is kept moist by steam, and at a temperature of 70° Fahr. 
If there be constipation, enemas and a dose of castor oil. Having 
ascertained the extent of the damaged . lung, wet cups should 
be freely and closely applied over the part, and free bleeding 
from cups encouraged by hot fomentations, and then followed 
by hot poultices of flaxseed meal. This is a better local stimu- 
lant than turpentine or mustard. Poultices should be changed 
every three hours, spread about half an inch thick, and in size 
to cover a little beyond affected part, so that if both lungs are 
affected it will form a regular jacket. Poultices should be 
covered by oiled silk. Over and above all, there should be a 
firm flannel roller, wide enough to extend from the arm-pit to 
the bottom of chest. It should be pinned evenly and firmly, 
beginning at neck, inserting a pin every inch, and proceeding 
down to the bottom, so as to confine the ribs, stop intercostal 
movement, and cause the patient to breathe by the diaphragm. 
Outside of all, bladders filled with hot water should, as far as 
practicable, be placed at the sides, so as to keep heat in poul- 
tice. Patient must not be permitted to lie too long in one 
position, as it gives the blood a tendency to gravitate into the 
weakened lung structure and congeal ; a change is very bene- 
ficial every two or three hours ; heat to feet, and general treat- 
ment for fever; diet, warm milk, with about five grains of 
bicarbonate of potassa to the half tumbler full, instead of lime- 
water, and warm beef tea, one or other at regular intervals 
every hour; no other diet of any efficacy; eggs and oysters 
strictly prohibited ; drinks are to be warm, and mucilaginous, 
as flaxseed, etc. 

There are, now, three drugs that must be unsparingly and 
persistently given, and these are, veratrum viride, opium and 
sulphate of quinine. 

A tablespoonful of tincture of veratrum viride, same amount 
of sweet spirits of nitre in four ounces or half a tumbler of 
water, of which one teaspoonful should be administered every 
half hour till pulse reaches sixty-five, and then at intervals of 
two or three hours, so as to check the current of circulation, 
so that when it passes through a weakened tissue effusion can- 
not take place — a balance maintained, a heart controlled, and 
by its influence on the connective tissue of lungs, prevents 
inflammatory action spreading into fresh parts. In some cases 
it is advantageous to combine a teaspoonful of tincture of aconite 
in the mixture ; to be continued as long as there is any fever. 

Opium or its alkaloid should be given in every case of 
pneumonia. It aids the action of the veratrum, prevents irri- 
tation, and so neutralizes the action of that drug that we are 
enabled to give it in larger doses. Besides, opium acts as a 
stimulant to the great sympathetic that so fully covers the 



314 DISEASES OF THE ORGANS OP RESPIRATION. 

lower lobe of the right lung and heart. As soon as the vera- 
trum is commenced, begin with the opium every three hours, 
and continue at regular intervals. The painful oppression of 
the chest and hacking cough soon disappears ; the noisy and 
frequent respirations soon become quiet and slower; the cyanosis 
of the face and lips gives way to flush ; the dry, scortching 
skin becomes cool and moist ; the heart regains its normal force 
and regularity ; its impulse, its sounds, its murmurs with the 
lung difficulty subside almost completely. It also counteracts 
the abnormal quantity of carbonic acid in the blood, and with 
the attainment of that object, languor and drowsiness disappear. 
Whether the crude drug or its alkaloid is selected, it must be 
borne in mind that the condition of the stomach is such that 
absorption is slow and imperfect; so to obtain readily the 
desired effect, it is best to administer it with an alkali ; to facil- 
itate its absorption and soften the effused products in the lung, 
such as opium pulverized, ten grains; Dover's powder, thirty 
grains; nitrate of potass, one drachm. Mix. Make twenty 
powders ; one every three hours ; or if the alkaloid is preferred, 
take one ounce of lemon juice; carbonate of potassa, enough to 
saturate ; add to one ounce of cinnamon-water, to which add 
one grain and a half of morphia. Dose, one teaspoonful instead 
of the opium. The effects of potassa on the lungs is very 
marked indeed. 

The next drug is quinine, without which there can be no 
successful treatment of pneumonia. Its action on the brain 
and great sympathetic is good, but in pneumonia, the size of 
the red corpuscles of the blood is diminished. Quinine restores 
them to their normal shape. Its presence in the blood is most 
salutary, when loaded with carbonic acid, in diminishing tem- 
perature. The dose should be such as will give a result, and 
continued, as it is freely eliminated by the kidneys, in alterna- 
tion with the opium. 

To relieve cough, a mixture of equal parts of syrup ipecac, 
squills, wild cherry and tolu, with muriate of ammonia, in half- 
teaspoonful doses. If there is tremor of hands, quivering of 
tongue, or delirium, alcohol in the form of brandy and milk 
or wine must be given. 

Delirium, coma, blueness or lividity of skin due to deficient 
aeration of blood: tincture of belladonna with a solution of ace- 
tate of ammonia to maintain fluidity. 

With the above treatment, during the stage of congestion 
and the early part of red hepatization, all signs of consolida- 
tion of the lung will give way and become absorbed, leaving 
the walls of the air cells unimpaired and elastic as before. 
Recovery is perfect, the breathing being mechanically and 
physiologically performed as in health. Neither is the inter- 



DISEASES OF THE ORGANS OF RESPIRATION. 315 

lobular structure altered, and there is no permanent thickening 
of the lung or bronchial tubes. 

The products of inflammation in a congested lung consist 
chiefly of exudation of fibrin, with liquor sanguinis, white 
and red corpuscles, and perfect absorption takes place. But 
sometimes cases have progressed too far, and about the end of 
the second week a change takes place; temperature goes down; 
there are rigors and sweats, and there is thick, viscid or muco- 
purulent matter expectorated, and the physical signs tell us 
that the lung is still solid but undergoing grave changes; the 
air does not penetrate it ; bronchial breathing still continues, 
but changes which indicate softening and ulceration begin to 
appear. 

Now our treatment must be changed to an alterative and 
tonic course, including iodide of potassa, tincture of iodine and 
ammonia ; irritating plaster, so as to keep an open discharging 
sore over the consolidated part; diet changed to milk, cream ; 
raw eggs, animal food. 

If during an acute attack there are the slightest indications 
of typhoid symptoms, antiseptics at once; brewers' yeast in 
milk, tincture of iodine and carbolic acid, as in Typhoid Fever, 
every hour. 

The degraded living matter in pneumonia in the early stage 
is chiefly bacteria, but at the end of the second week vibrios 
are often to be found on tongue, in urine and stools. 

Chronic Pneumonia — In the large number of cases is con- 
fined to the lower lobe of the right lung. The patient may 
recover with that lobe perfectly consolidated, in which condi- 
tion it may remain for years ; or the products of inflammation 
may break down and recovery take place; whereas, in another 
class of cases, the non-seration of blood and local irritation tells 
badly on the nerve-centres, and a degradation of living matter 
takes place, and we have the tubercular germ, or in other words, 
the ulcerative process of pneumonia changes into that of con- 
sumption of lungs — tubercular. It makes little difference how 
the inflammation originally started; its termination, unless 
managed with the very greatest nicety, is apt to take that 
course. 

The treatment of chronic pneumonia is the same as should 
take place following any and every case of acute until the lung 
clears. Diet nutritious and generous, flannel clothing, daily 
bathing, followed by inunction of oil; bowels regulated, appetite 
stimulated with tonics; irritating plaster to be kept all the 
time, if possible, over the seat of consolidation. Encourage free 
suppuration. Iodide of potassa, carbonate of potassa in altera- 
tives. Expectorants in sufficient quantity to keep down cough. 
In other words, a tonic and alterative course. 



316 DISEASES OF THE ORGANS OF RESPIRATION. 

PLEURISY. 

Inflammation of the pleura or serous covering which invests 
the lungs and inner surface of the thorax ; is met with either 
in the acute, sub-acute or chronic form; confined to one side 
or to both. 

The cause is usually exposure to wet or damp or cold, or frac- 
tured ribs. 

The symptoms in the acute form are languor, debility, pain 
in head, back and calves of legs, chilliness, rigors and a fever, 
with hot, dry skin ; temperature not so high, unless pneumonia, 
to a limited extent, exists — 101° to 103° F. ; cheeks flushed; hard 
and quick pulse ; increased frequency of respirations ; an acute, 
lancinating pain in the side, called a stitch or catch, commonly 
below the nipple, over attachment of diaphragm on front of chest. 
This stitch or pain is aggravated by expansion of the lung in 
inspiration, coughing, or moving, or lying on affected side, and 
by pressure. A harsh, dry cough, with frothy expectoration ; 
anxiety and restlessness; scanty and high-colored urine. Over 
the seat of stitch or pain can be detected, quite early, a friction 
sound, caused by the inflamed, congested and roughened sur- 
faces of the covering of the lung rubbing against the pleura 
of the ribs. This rubbing resembles the rubbing of two pieces 
of brown paper or stiff silk against each other ; generally best 
heard and even felt by the hand forty-eight hours after rigor, 
often earlier. It ceases when inflammatory action is arrested, or 
when the two surfaces become moist and smooth by effusion of 
serum, or when adhesions by bands of lymph take place from 
the affected surfaces, or when effusion is in great abundance. 

The duration of an attack of pleurisy should be but a few 
days if properly treated ; but if mismanaged, it may be run 
into some of its terminations or effects, or into a chronic form. 

Effusion of serum may take place, to the amount of a few 
ounces or of several pints. It may be pure serum, liquor san- 
guinis, or serum and blood. When excessive it compresses 
the yielding lung, suspends its functions, displaces the heart, 
and somewhat distends the thoracic walls. This effusion is 
called hydothorax. 

When pleurisy terminates in a breaking-down of lymph, or 
suppuration or pus, which accumulates in the cavity of chest, 
it is called emphyema. When this occurs constitutional sjmip- 
toms are more serious — rigors, febrile disturbance, often of a 
hectic character ; tongue brown, dry and thickly coated ; pus 
sometimes forms a bulging tumor in intercostal spaces ; fluctua- 
tion can be detected, or sinuses may form at distant parts, and 
it may be evacuated ; or ulceration of costal pleura may take 
place, pus finding its way through muscles and skin, and form- 



DISEASES OF THE ORGANS OF RESPIRATION. 317 

ing a fistula in the chest ; or, more rarely, the covering of the 
lung may be perforated, and the pus find an entrance into the 
air cells, and be expectorated. 

Whatever the nature of the effusion,' serum, or serum mixed 
with blood and liquor sanguinis, or lymph broke down (pus), 
it will cause, according to its extent, dullness on the lower part 
of the chest, extending upwards. The respiratory murmur of 
the lung is diminished. The chest may be so filled up that the 
lung may be compressed, so that little or no air can enter the 
bronchial tubes, so that no murmur can be heard. The fluid 
also prevents any intercostal movement. Patient cannot lie 
down. 

Treatment. — Acute pleurisy should be treated with great 
energy, in order to prevent such grave complications. Wet 
cups or turpentine to redness over the seat of pain, followed 
with hot, moist linseed poultices, in which tincture of opium 
is freely incorporated ; changed frequently. A flannel roller 
should encase the chest from the axillae down to the base of 
ribs over poultice ; the latter can be kept hot by bladders of 
hot water. Patient put to bed, perfect rest, avoidance of talk- 
ing or full, deep inspiration ; breathe chiefly by diaphgram, so 
as to prevent friction between inflamed surfaces. Then one 
tablespoonful of tincture veratrum viride, tincture of aconite 
and sweet spirits of nitre in half a tumbler of water, of which 
one teaspoonful should be given every hour till pulse reaches 
70 ; then at intervals of two or three hours apart. Give half 
a grain of pulverized opium, five of Dover's powders in an 
infusion of pleurisy root every three hours, or double the 
quantity if there is not a speedy relief. Open bowels if con- 
fined; keep heat to feet. If the skin does not perspire well 
with pleurisy root tea, add compound tincture of serpentaria 
in half-teaspoonful doses. If symptoms are urgent, inject hypo- 
dermically one-third oi a grain of pilocarpin; when it acts 
there is immediate relief and a cure; so it is unnecessary to 
lay down rules for diet or drink, which should be gruel, milk, 
broths, cream of tartar, water or lemonade. 

With such new and definite remedies, we have the means of 
getting rid of all acute and sub-acute cases in twenty-four or 
forty -eight hours. Tonics, good, nourishing food during con- 
valesence ; quinine, in alternation with iodide of potass, is espe- 
cially valuable. 

Chronic Pleurisy may follow an acute or sub-acute attack, 
if inefficiently treated or in a feeble patient, or it may come 
on of itself. 

There is no fever, rarely friction sound, but more generally 
effusions of lymph, with adhesions in the form of threads, 
bands, or ribbon-like exudations between the two pleura s, which 



318 DISEASES OF THE ORGANS OF RESPIRATION. 

interfere with respiration, especially if deep, or with move- 
ments, as raising hands to face, turning sideways when the 
characteristic stitch is experienced. 

As there is in all cases of chronic pleurisy adhesions going 
on, the best method of treatment is to build up the general 
health by good substantial food, well-regulated secretions, 
woollen clothing, rest for a few months. If that is not prac- 
ticable, an avoidance of positions in which the catch is expe- 
rienced ; then a general alterative course, with iodide of potassa 
in alternation with tonics. Over the seat of adhesion, which 
is readily known by the stitch in certain postures, the irritating 
plaster should be kept constantly applied, spread fresh every 
morning, and if suppuration is not free, occasionally rub over 
with croton oil. The irritating plaster has a better resolvant 
action than repeated fly blisters or iodoform ointment. Usually 
about three or more months are necessary to break down a 
pretty firm adhesion. 

The obstacle to free, deep inspiration, and that peculiar 
retraction of chest will disappear as soon as the adhesion gives 
way. 

To Promote the Effusion of Serum in the Cavity of Chest. — The 
best of diet to raise the standard of blood ; tonics to stimulate 
appetite. Try first effusion of squills and digitalis, followed 
with diuretics, diaphoretics and hydrogogue cathartics ; those 
failing, alteratives and iodide of potass ; all remedies useless, 
tap the chest between sixth and seventh ribs, two-thirds the 
distance from the spinous process of vertebras to middle of 
sternum. The old-fashioned trocar and canula is better than 
the aspiration. In emphyema, aspiration should be performed 
several times. The thorax to be tapped long before difficulty 
of breathing, or threatened suffocation takes place. 

PLEURODYNIA. 

Neuralgia of the pleural nerves. It may also affect the inter- 
costal. The nerves are weak from some cause and are irritated 
by rheumatism or the germs of syphilis. It is called false 
pleurisy. 

Symptoms. — Great impairment of general health, attended 
by some morbid condition of blood, which gives rise to great 
mental depression and physical prostration. Phosphates and 
chlorides in urine. The pain or stitch is non-inflammatory, 
sharp, lancinating, — comes on and leaves suddenly. Although 
it is the cry of a nerve for purer, more nutritious blood, the 
lactic acid of rheumatism has much to do with it; still, often 
present in other blood poisons. Apt to come on if fatigued. 
More liable to affect left side than right. 

Treatment. — Alteratives and tonics as to cause; irritating 



DISEASES OF THE ORGANS OF RESPIRATION. 319 

or some stimulating plaster locally. Aconite, white bryonia 
and quinine ; iodide potassa in fluid extract of asclepias. If 
no relief, hypodermic injection of morphia. 

No depleting treatment admissible. ' The very best of food, 
ease of mind and rest of body. 

PULMONARY CONDENSATION. 

Infiltration or condensation of the lung structure may occur 
in various ways, outside of the ordinary process of inflamma- 
tion or tubercular deposit. 

Pulmonary Apoplexy. — The effusion of blood products 
into the air-cells of the lung and its coagulation there, may 
occur in any part of the lung ; may be circumscribed or dif- 
fused, may be very small or occupy quite a large space. It is 
very apt to take place from the inhalation of such gases as 
chlorine, or may arise from disease of the heart, lung, blood- 
vessels or some blood disease. 

In its treatment, the irritating plaster over seat of dullness ; 
iodide of potassa with carbonate of ammonia in some vegetable 
alterative. In some cases, tincture of belladonna has a very 
resolvent action. Expectoration to be encouraged by mucila- 
ginous drinks, linseed tea, marshmallow and squill. 

Pulmonary Fibroid Infiltration. — Consolidation of the lung 
with fibrous tissue, when it becomes hard and tense, intersected 
with fibrous tissue, either in bands, or tough white deposits. 
This not only gives rise to dullness on percussion, but restrains 
the expansive movements of the lung, and no vesicular mur- 
mur can be detected. This form of condensation is often a 
result of pleurisy. The band or adhesion between the two 
pleuras, instead of simply adhering to the covering, penetrates 
into the substance of the lung and invades its substance com- 
pletely. 

A long alterative and tonic course. The local use of the 
ozonized clay over the seat of dullness continuously, if it causes 
no redness of the surface, is most advantageous. If it causes 
redness, its use to be suspended, when redness disappears, reap- 
plied. The iodide of potassa, muriate of ammonia and bella- 
donna are the best solvents. Time and a persistent use of those 
drugs are indispensable. 

Condensation due to Collapse. — Perhaps the most common 
form of collapse is that due to a plugging up of the bronchial 
tubes with effused lymph in acute bronchitis, where the lymph 
acts as a plug or pork, preventing the inspired air from reaching 
the air-cells. This plugging up gives rise to alarming collapse of 
a lobe or entire lung. In very feeble subjects, children with 
hooping-cough or aged persons with bronchitis, the tubes may 
become plugged with matter from a sheer inability to expecto- 



320 DISEASES OF THE ORGANS OP RESPIRATION. 

rate, and collapse and condensation follow. Stimulants, tonics, 
warm beef tea, may be tried, with local stimulants in the form 
of hot poultices, are the best remedies. 

In pleuritic effusions the lungs are greatly compressed, and 
the margins are liable to be thickened, and in some cases, 
calcareous degeneration sets in. 

Pulmonary Cancer. — The cancer-germ may find its way 
into the weakened structure of lung tissue, and manifest in 
its growth any of the forms of carcinoma. Irrespective of the 
cachexia, which is usually strong, the pain anterior and pos- 
terior in the chest is the best point upon which to base a diag- 
nosis; because, the dullness on percussion, the lack of inter- 
costal movement, the emaciation, sweats, difficulty of breathing, 
purulent expectoration and failure of the powers of life, are 
present in both consumption of the lung and chronic pneu- 
monia. Its common location in the middle of a lobe is of no 
importance. The only hope of relief or cure consists in the 
very free use of hyosciamus and opium, and in the persistent 
administration of antiseptic drugs to destroy the germ, as ozon- 
ized saxifraga, ozone- water, chian turpentine, sulphur. 

Pulmonary Gangrene. — The process of dying, or gangrene 
of lung structure may follow any form of condensation where 
the vital forces are very feeble. It is more prone to follow in- 
flammation if the constitution is broken down by drink and ex- 
cess, still not a necessary result. In any of the forms of con- 
densation, if debility becomes great, loss of flesh rapid, heavy 
hectic fever and night sweats, pulse weak, face anxious, breath 
very offensive and the expectoration fetid, greenish, putrid, 
gangrene may be suspected. Gangrene in lung if limited to a 
small area is not necessarily fatal, although a vital organ has 
been smitten ; if, however, it is diffused and spreads, the hopes 
of cure are not good. A stimulating treatment should be tried. 
Ammonia and cinchona, quinine and mineral acids, chlorate 
of potass and muriatic acid, inhalation of antiseptics. The best 
of nourishment, soups, milk, cream and alcholic stimulants to 
arrest change. 

PULMONARY CONSUMPTION. 

Phthisis pulmonalis is due to the germ tubercle finding its 
way either into the mucous membrane of the bronchi or sub- 
stance of the lung, and being deposited into weakened tissue 
from the blood. It not only localizes itself, but being a living 
body, if conditions are favorable, it grows with great rapidity. 
Before any form of tubercular consumption can exist, it is 
essential that the patient must have either inherited or acquired 
that blood disease, tuberculosis, a condition of impaired nerve 
force in which an alteration or change or degradation of living 



DISEASES OF THE ORGANS OF RESPIRATION. 321 

matter takes place into the disease germ tubercle. Destructive 
changes in the lungs may take place from other causes, and 
the irritation which those changes produce invariably depre- 
ciates nerve force and brings about tuberculae, such as : 

In the glucose diathesis and chronic alcohism, where the 
blood is loaded with grape-sugar, it so weakens the nerve 
centres, and irritates the large aerating surtace of the lower lobe 
of the right lung that passive congestion takes place ; patient 
becomes very tubercular, and he does not die from diabetes or 
the action of the alcohol, but from the tubercular germ eating 
up his lungs ; pulmonary phthisis. 

Again, in pneumonia, the effused products of inflammation 
not absorbed create an irritation ; tuberculse is acquired, and by 
and by, alongside the coagulum of inflammation, the germ 
tubercle is effused, and a destructive process of germ growth is 
set up. 

Perhaps from a lift or strain a small vessel might rupture in 
a healthy individual, the blood congeal in the air-cells, irritate 
and depreciate the nerve centres, tuberculosis is engendered, 
and soon tubercle is deposited around that clot, and a destruc- 
tive process established. And so with other foreign bodies, as 
fibroid tissue, solid particles in various occupations, and also 
the germs of syphilis and cancer. 

These, of course, are complications and states of which we 
will not now speak, but fall back on our general definition. 

The typical form of depression of the nervous system that 
gives rise to the degradation of normal living matter into the 
disease-germ tubercle may be hereditary or acquired, and when 
once established, contagious and infectious. Tuburcle consists 
of small, round cells or cysts in a cellulose membrane floating 
in the blood, ready the moment any weakness takes place in a 
tissue to be effused with other products. Once that takes place, 
the countless millions of microscopical progeny in the mother- 
cyst or cell penetrate its walls, and grow, multiply and die like 
other living matter. Their growth, vitality and production 
depends a good deal on the amount of partial death present in 
the part, and its character. Tubercle differs from all other 
diseased germs and living matter in its process of death ; they. 
in their healthy, active state, are albuminoid bodies ; in their 
process of growth and death they become milky, then cheesy, 
then calcareous, or an inorganic body — phosphate of lime. 

Of tubercular pulmonary phthisis there are two forms — acute 
and chronic. 

Acute Phthisis Pulmonalis commences suddenly, with 
slight rigors, fever, rapid pulse, difficulty of breathing, cough, 
bleeding from lungs, hoarseness, loss of voice, lungs clear from 
top to bottom, profuse sweating, diarrhoea, rapid emaciation, 

33 



322 DISEASES OF THE ORGANS OF RESPIRATION. 

tubercle being only effused on the bronchial mucous mem- 
brane, called mucous or laryngeal phthisis. There is "another 
rare acute form — lungs pretty clear, but mottled all over with 
tubercle, like grains of barley, chiefly in middle and lower 
lobe; patient dies early in both forms from apparent exhaustion. 

Chronic Pulmonary Phthisis. — This is a common form 
generally met with in the germ tubercle, finding its way into 
the weak structure of the apex of the upper lobe of the left 
lung, spreading downwards on the apices of both lungs, and 
growing and effusing from above downwards. There is first 
effusion of tubercle in weakened structure, then growth, pro- 
digious multiplication of germs, which soon interfere with 
passage of air into air-cells. Then nature desires to protect 
herself from the presence of those bodies; she excites less or 
more inflammation around them ; lymph is effused around the 
germ tubercle, and encloses or encysts it; and between the 
disease-germ and inflammatory products, the lung becomes 
solidified in its substance, and does not permit ingress of air. 
After an indefinite period the germ dies, yields to the influence 
of adverse conditions, and is expectorated or absorbed either 
in its albumenoid, milky or cheesy state, leaving a cavity in 
the lung. In more rare cases there may be deposit of tubercle 
in the middle of a lobe ; it may grow by aggregating other 
germs, or of its own innate property, and form a mass albu- 
menoid, milky, cheesy, and finally calcareous, and break down 
and be expectorated, leaving a vacuum, cavity, or cavern in 
the lung ; the formation of such a cavity is called a vomica. 
The germs of tubercle may be deposited in the nerve centres, 
sub-mucous coat of stomach and bowels, in mesenteric glands, 
liver, and kidneys. 

The predisposing cause of pulmonary consumption is the 
presence of tubercle in the blood; the exciting cause is some 
irritation, as cold, damp, dust, foreign bodies, mechanical strains, 
lifts — any thing we can imagine that would weaken the vital 
capacity of the bronchial mucous membrane or lung substance. 

Symptoms. — Languor, lassitude, debility, with increased 
heat ; respirations and pulse ninety to one hundred ; emacia- 
tion, protuberant eye balls, clubbed nails, loss of hair ; cough 
at first dry, subsequently expectoration, difficulty of breathing, 
haemoptysis or spitting of blood, night sweats, hectic flash on 
cheeks, burning sensation in hands and feet, indigestion, loss 
of appetite, loathing of fatty articles, weakness of voice, hoarse- 
ness or loss of voice ; a festooned appearance at reflected edge 
of gums, often diarrhoea ; often a dull, aching pain in shoulder 
blades. The increase of heat and wasting bear a direct ratio 
to the germ growth and deposit. When tubercle is deposited 
in the sub-mucous tissue of the bronchi, or on its free surface, 



DISEASES OF THE ORGANS OF RESPIRATION. 323 

symptoms are greatly aggravated, and bleeding from the lungs 
more common ; often slight congestion of liver and kidneys, so 
that urine often contains sugar or albumen. In women, cessa- 
tion of the uterine function is common. As the case progresses, 
the debility, wasting, sweats, and other symptoms become worse 
and dairy more marked. Diarrhoea, at first due to altered or 
acid secretions, is now dependent on the germs in the coats of 
bowels, and to ulceration about ilium and colon ; aphthae about 
mouth and the fauces ; tenderness and oedema of extremities ; 
mental faculties usually remain clear until death. 

Now all the above symptoms are easily explained by the 
presence of a disease-germ in that fluid. This germ may have 
lain quiescent for many years in the blood, ready to spring 
into activity the moment conditions favorable for its growth 
should take place, and the pabulum adapted for its nutrition 
should be at hand. It is also true that if a high standard of 
health could be maintained by the affected individual, the 
germs would undoubtedly die out. The tubercular germ in a 
state of activity uses up in its own nutrition, growth, and 
development the vital elements of the blood and tissues. 

Physical Signs. — If it is the bronchial form, lungs will be 
clear from top to bottom ; hoarseness, loss of voice, and haemop- 
tysis predominant. If it is the lung or chronic form, dull- 
ness at the apex of left or both lungs, proceeding downwards ; 
if consolidation is not perfect, feeble or harsh respiratory mur- 
murs may be detected, audible and prolonged — perhaps a faint 
crepitus or dry crackling ; if tubercular deposit is heavy, there 
is flattening of ribs and absence of intercostal movement. The 
dullness on percussion is decided, and as the case progresses, 
deficiency of chest movement. As tubercles die and are being 
expectorated, small and large crepitation. If tubercle has eaten 
away lung substance, there will be a sinking in or retraction of 
intercostal spaces, and there may be an unusual clearness on 
percussion. The respiration will be cavernous, as coming from 
an empty cavity ; the upper lobe of right lung may be dull on 
percussion in .disease of the liver — passive congestion without 
tubercle. As a rule, tubercle deposits itself in apex, and pro- 
ceeds down ; inflammation at base, and proceeds up. Tubercle 
ma} r be deposited at base in chronic pneumonia, in chronic 
alcoholism and diabetes. 

It is the custom to divide it into stages : (1) of effusion of 
tubercle; (2) perfect consolidation of lung from tubercular 
deposit or growth, or both ; (3) death or breaking-down of the 
living mass. It is often complicated with asthma, bronchitis, 
pleurisy, etc. 

It is impossible to, speak of its duration with any degree of 
precision. The bronchial is rapidly fatal, unless well man- 



324 DISEASES OF THE ORGANS OF RESPIRATION. 

aged ; the deposit in lung essentially chronic, and admits of 
retardation, and often of a good cure with proper remedies. 

Pulmonary tuberculosis is contagious and infectious. The 
living particles of tubercle are so minute as to be supported by 
the atmosphere, and carried from individual to individual. 
It is not pre-eminently contagious, like some forms of conta- 
gious disease-germs, but it is certain that the living, growing 
tubercle escaping in the breath, and breathed in by another, 
will contaminate. This living contagion is to be much dreaded 
in our country, in which mixed races exist, because the pas- 
sage of the germ from opposite races increases its virulence or 
activity. There is also a giant form of germ tubercle among 
our domestic animals, as chickens, pigs, cows, horses, sheep, 
from whom man may receive the contagion by breath, and 
whose flesh is unfit for food. 

Etiology. — When the adverse condition of vital force takes 
place, when living matter is degraded into the germ tubercle, 
the whole of the tissues and structures of the body undergoes 
great changes. The hair becomes dry, like tow, the skin 
thin, muscles soft and flabby, bones with marrow deficient in 
proper material, secretions sluggish, acidity and dyspepsia, 
and general impairment of vitality, with the presence of the 
germ in a weakened structure, its slowness or rapidity of growth 
being dependent upon the condition of vital force. A truly 
gigantic disease, when extreme, terminates in non-procreation. 

The Treatment will have to be laid down under general 
heads. 

(1.) General Rules. — Every possible means to improve the 
general well-being and comfort of patient, good reading, moral 
and religious surroundings; improvement of general nutrition 
by every possible means, the best of food for making rich blood; 
abode to be healthy, city in winter, sea or mountain air in 
summer, an even temperature, exercise in open air, never to 
fatigue, driving, sailing; well ventilated apartments; flannel or 
silk next the skin ; daily tepid sponging or bathing, followed 
by brisk friction with towel, flesh brush, dry hand ; every pos- 
sible means taken to increase strength or vital stamina, secre- 
tions of bowels and kidneys to be stimulated; appetite promoted 
by tonics. 

(2.) Diet to be rich in blood elements, but to be varied, animal 
and vegetable ; the most nutritious animal food ; if stomach 
fails to digest, follow with pepsine ; warm milk from cow ; cream, 
raw eggs; extract of malt; Iceland moss and quinine jelly; 
wine, bitter ale ; an interval of not longer than three hours 
between meals; besides, abundance of diet, ripe fruits. 

(3.) Location. — Seaside or mountain tops in summer, chiefly 
for ozone. Sea air, besides, has iodine and bromine. Change 



DISEASES OF THE ORGANS OF RESPIRATION. 325 

is very beneficial in early stages. Patients requiring a sooth- 
ing, moist atmosphere should go to Florida ; those a bracing, 
vivifying air, Colorado. Mountain climate is often of great 
service. 

(4.) Local Applications to Chest. — In all cases some stimulating 
application over devitalized part, so as to raise standard of 
vitality, promote absorption. Nothing superior to the irritating 
plaster. If it cannot be borne, iodoform ointment, belladonna, 
aconite, and chloroform, or croton oil liniment, or dry cups, etc. 

(5.) Remedies to palliate, 'mitigate, or arrest excessive waste. 

If the wasting is a prevailing and persistent symptom, bathe or 
sponge off the chest and back with soap and tepid water, dry 
well, rub or shampoo, or palpate by a vital or young person, 
then rub in four or more ounces of warm olive oil every night 
before bed-time, rubbing or shampooing gently till it has made 
its way into the skin. Extract of malt or Bass's ale arrests to a 
certain extent waste going on. If there is fever, heat, respirations, 
and pulse up, which means vitality down, tincture of aconite 
and digitalis should be given to keep the pulse at seventy. If 
there be acidity and indigestion, compound tincture cinchona and 
mineral acids, aromatic sulphuric acid and quinine, or gentian 
or kurchicine. 

If there be any diarrhoea, a pill of equal parts of opium and 
tannin, a grain of each after every movement of bowels when 
they exceed one per day. If there be haemoptysis or bleeding 
from lungs, digitalis, erigeron, gallic acid, oil of turpentine, and 
sulphuric acid, tannin and nitric acid. To check night-sweats, 
aromatic sulphuric acid and quinine, or nux vomica. To. relieve 
cough, syrup senega, squills, ipecac, tolu, lobelia, marshmallow, 
slippery-elm, flaxseed tea and lemon juice, raw eggs and salt; 
or syrup of poppies with ammonia. To lessen expectoration, 
inhalations of turpentine or carbolic acid. To procure sleep, 
extract of hyosciamus and opium. To procure absorption of dead 
germs, iodine and bromine. For the relief of hectic, aromatic sul- 
phuric acid, sulphurous acid, and other antiseptics. 

(6.) Remedies to destroy the micro-organism tubercle by inhalation, 
and promote its absorption or elimination when dead. 

The fever of phthisis, the afternoon or evening exacerbation of 
hectic, is not due to inflammatory action but to putrid infection 
of tubercular products. Tuberculosis is an infectious disease 
of germ origin, induced by certain micro-organisms, generated 
in the body and multiply in it, and the only rational means 
of curing it is the employment of means calculated to annihi- 
late these organisms. There can be no doubt that pulmonary 
consumption can be propagated by direct infection from man 
to man, and from animals to man, and man to animals. The 
unity of the tubercular germ has been fairly ascertained, the 



326 DISEASES OP THE ORGANS OF RESPIRATION. 

same in the lungs as in the lymphatics, and we have to deal 
with a disease of germ origin readily infectious, and we have 
thus a clear indication for antiseptics, both local and internal. 
In pulmonary phthisis, the toxaemia is attributable to two causes : 
the germ itself, and the chemical factors of death and absorption. 

Volatile antiseptics, in an oral nasal respiration, are attended 
with great benefit; such a formula as iodoform dissolved in 
sulphuric ether, then add alcohol, chloroform, and carbolic acid 
in sufficient quantity. Place in a respirator or saturate a sponge 
and inhale. 

The inhalation of carbolic acid alone proves very beneficial. 
It destroys the germs, being so destructive that an appreciable 
improvement takes place at once. It should be used frequently 
either in a steam atomizer or a common pitcher of warm water. 

Benzoate of soda, in solution five per cent, in an inhaler for 
half an hour each day, is an agreeable and efficient change. 

(7.) Remedies introduced into the stomach to destroy tubercle in 
the blood. 

Ozonized glycerine, in doses of from half to one teaspoonful 
thrice daily, is one of our best remedies as a scavenger in dis- 
eased blood, destructive to all micro-organisms or disease- 
germs, and at the same time vitalizing to healthy blood. Ozone- 
water also of great utility. 

Carbolic acid and tincture of iodine: two drachms of car- 
bolic acid, one of tincture of iodine; two drachms of muriatic 
acid, one drachm of oil of eucalyptus, first rubbed up in sugar 
and then added to half an ounce of alcohol, all to be added to 
fifteen ounces of water ; a teaspoonful to be given every two 
hours. 

Hypophosphite of potassa, in five-grain doses, has also a 
marked destructive effect on the germ; best administered in 
extract of meat. 

As a change, the chlorate or permanganate of potassa not to 
be overlooked. 

Chloride of lime, in doses of three or four grains, in sweet 
milk or glycerine immediately after meals, has great efficacy 
in destroying the germs, arresting the night-sweats, healing 
and drying up pulmonary lesions. The following preparation 
is more stable and elegant: Carbonate of lime, two ounces; 
saturate with muriatic acid and then add six ounces of water, 
then filter. Each drachm contains sixteen grains of the salt 
and can be given in water or milk. 

Sulphur, sulphur- water, sulphurous acids, are anti-germ drugs 
and are of utility. 

(8.) Alteratives and tonics. 

As phthisis is essentially a chronic disease, a general altera- 
tive course is advisable to effectually cleanse out the debris of 



DISEASES OF THE ORGANS OF RESPIRATION. 327 

dead germs and aid in overcoming the cachexia upon which 
it originally depended ; tonics are not to be overlooked ; so that 
a general course is very proper for some months. Vegetable 
alteratives, as phytolacca, stillingia, tag alder, corydalis, and 
tonics, as cinchona, Hydrastis, mineral acids. 

In the treatment and cure of consumption, the very depths 
of science, the whole range of art, should be ransacked for anti- 
septic drugs, like the glycerite of ozone, to kill the germ and 
reconstruct shattered vital force ; and no stone must be left 
unturned when we can see any reasonable prospect from local 
or general treatment. But while we urge upon the profession 
and the suffering wrecks of humanity in our midst the impera- 
tive necessity of antiseptics, still the use of hygienic measures, 
aided by a proper climate, does much for the prolongation of 
life and the arrest of the disease. Hygiene, pure air, a warm, 
even temperature, an avoidance of all insanitary conditions, 
are trusty aids in treatment, and should never be omitted ; 
but antiseptic drugs and an ozone atmosphere that will enter 
and permeat the pulmonary circulation act most effectively on 
the disease in lung tissue. By such measures, combined with 
constitutional measures, we can do much in the way of cure ; 
and even if the enemy gains a foothold in the fortress, we may, 
by strengthening the garrison, cause him to be expelled and 
the breach repaired. The arrest of consumption is undoubtedly 
due to the good judgment of the physician in charge, and to 
his adaptation of the means at his command. 

CANCER OF THE LUNGS. 

This is rather a rare disease, but when met with is usually 
of the medullary form. The very spongy and elastic structure 
of the lung enables the cancer germ to deposit, to grow and 
breed with a rapidity that is truly astonishing, consequently 
the entire mass consists of pure germs. 

The symptoms may resemble pulmonary tuberculosis or may 
be obscure, but the pain, anterior and posterior, will be our best 
guide to a correct diagnosis. The cachexia is also well marked. 
Treatment is of no avail. Nevertheless all the symptoms 
should be mitigated, the sensorium blunted with hyosciamus, 
conium and opium, so that the patient does not experience the 
terrible pain incidental to the disease. 



328 DISEASES OF THE ORGANS OF DIGESTION. 



DISEASES 

OF THE ORGANS OF DIGESTION: 

MOUTH, STOMACH, BOWELS. 



DISEASES OF THE MOUTH. 

The tongue is exposed to many sources of disease and injury. 
It is a highly sensitive organ; hence, slight affections of its 
mucous membrane or its muscular fibres are highly painful. 

Glossitis. — Inflammation of the substance of the tongue is 
a rare affection, since mercury has been nearly discarded from 
practice ; when it occurs it is usually dependent upon consti- 
tutional causes, or some irritation applied directly to the organ. 

In either case there is fever, great nervous depression, and 
debility. The local symptoms are those of pain, heat, redness, 
swelling. The tongue becomes of a very deep red color, and 
so swollen that it fills and protrudes out of the mouth. It 
usually comes on quickly, and is often attended with urgent 
symptoms, and requires prompt treatment, as active purga- 
tives, followed by hypodermic injections of one-third of a grain 
of pilocarpin, heat to feet, poultices of slippery elm to tongue, 
and suppositories of veratrum viride and gelseminum per rec- 
tum. If mercury is the cause, iodide of potassa, chlorate of 
potassa gargles, and sulphurated potassa baths, or both. 

Ulcers, Cracked, and Other Morbid States of the Tongue. 
— The tongue is not only an index of the condition of the 
stomach and alimentary canal, but often a valuable criterion 
as to the state of the nervous system, and intensity of blood 
poisoning. 

(1.) The Strawberry Tongue of scarlet fever, the raw, fleshy- 
looking tongue of gastritis, the patchy, ulcerated tongue of 
typhoid fever, and other states of great exhaustion. The sore- 
ness in the organ is relieved by bland food, mucilaginous 
drinks, smearing it with vaseline ointment, or using mouth 
washes of chlorate of potassa and glycerine, or borax and 
honey in infusion of bayberry. 



DISEASES OF THE ORGANS OF DIGESTION. 329 

(2.) Ulcers, the Result of Mal-nutrition, or of inflammation, or 
irritation from old stumps ; the removal of the cause, the use 
of emetics and bitter tonics. As those ulcers are generally 
very small, superficial, without definite shape, very sensitive, 
most numerous at tip or bridle : in addition to internal tonics 
they are readily cured by infusions of golden seal and borax, 
or sage-tea and borax. 

(3.) Mercurial Ulcers are common : not so much to internal 
exhibition of mercury as to the use of amalgam in filling teeth, 
especially large cavities. They are very easily recognized by 
the foetor of the breath, affection of gums, salivation. The 
removal of the cause; the use of chlorate of potassa as a mouth- 
wash, and iodide of potassa internally. 

(4.) Syphilitic Ulcers are easily recognized by their copper- 
colored appearance. In mild attacks most common on front 
part of tongue and edges and superficial aspect; in more aggra- 
vated cases they occupy the root, and are deep and intractable. 
The general treatment for syphilis, with mouth-washes of infu- 
sions of sage and borax, hyssop and chlorate of potassa, golden 
seal, gold thread. 

There are also tubercular cancerous, and other forms of ulcer- 
ation ; constitutional remedies, with local antiseptics. 

(5.) Cracked Tongue. — They may be fissures, transverse, if intes- 
tinal irritation ; or longitudinal, of kidney irritation ; or, more 
generally, they are the clefts and fissures of mal-assimilation, 
forming a series of irregular grooves often quite deep, render- 
ing eating, speaking, or reading difficult and painful. Cured 
by sage-tea and borax, glycerine and chlorate of potassa, golden 
seal and alum. 

(6.) Surface of Tongue often presents patches of baldness, one 
or more smooth oval patches ; no ulceration or fissure, indica- 
tive of a syphilitic taint ; alteratives and tonics. 

(7.) Warts are usually met with at the edges of the root of 
the tongue, and are presumptive of syphilis. Condylomata are 
not uncommon in same disease. Papillary patches, thickening, 
induration, give an unpleasant feeling to the organ in speaking, 
causing thickness of speech called psoriasis and ichthyosis ; 
often precursor of cancer. 

(8.) Hypertrophy of Tongue is rare ; when it does exist, it is so 
large that the mouth is too small for it. In some instances it 
protrudes as far as the chin. Its removal by ecraseur is the 
only cure. 

(9.) Tongue-tie, when the frsenum or bridle is shorter than 
usual, the movements of the tongue are interfered with, the 
bridle has simply to be cut, 

(10.) All Kinds of Tumors, fatty, fibroid, encysted, etc., are 
met with here ; extirpation is the proper remedy. 



330 



DISEASES OF THE ORGANS OF DIGESTION. 



(11.) Ranula (so called because the voice is said to be croak- 
ing like a frog's), is a semi-transparent fluctuating swelling as 
large as a walnut, situated under the tongue. It consists of a 
dilation of Wharton's duct of sub-maxillary gland. Painting 
it w T ith the perchloride of iron, or passing a seton through 
it, is usually sufficient to effect its disappearance, using mouth- 
washes to heal and strengthen. 

Cancer of Tongue may be of the medullary, scirrhus, or 
epithelial form. Whichever it may be, there is a tendency to 
speedy ulceration. A foul, sloughy sore forms, with ragged 
edges and indurated base. 

Symptoms. — Cancerous cachexia, severe pain, profuse sali- 
vation, difficult articulation and deglutition, attacks of haemor- 
rhage, great swelling of the whole organ, often sloughing, can- 
cerous deposits in all the surrounding parts ; mouth may be 
filled with a cancerous mass, threatening suffocation ; disease 
is very rapid in its course. 

Treatment. — Pain must be alleviated with opium and large 
doses of conium or hypodermic injections ; nutrition kept up 
by milk, cream, raw eggs, juice of beef. Remove cancer with 
the ozonized chloride of chromium in paste or in liquid. Gen- 
eral treatment for cancer. 

TOOTHACHE. 

Toothache from Caries. — Softening and decay of denture, 
causing great pain when the central pulp is reached. This is 
the most common form of toothache, and is due to tooth star- 
vation, the patient's diet being devoid of phosphates. He eats 
no corn bread nor uses oatmeal, and the bony elements of flour 
are destroyed with alum and other deleterious baking powders. 
Heat and cold are also destructive; so are disease-germs or their 
micrococci in the mouth ; but the great increase in decay of teeth 
at an early period of life is due to the increase of nervous dis- 
eases which correlates to the deterioration of the teeth, each 
influencing, and, in a measure, causing the other. Besides, the 
modern system of over-stimulating the nerve force by a too 
early education, causing a defective power of assimilation and 
tissue formation, especially in the teeth. It may also be due to 
the malformation of enamel and bone; to the use of mercury, 
germs of tuberculse, to indigestion, improper care of the teeth. 
It may be reflex, as in pregnancy. 

Treatment. — Removal by scraping away of decayed portion 
and then stopping with gold or gutta-percha; no amalgam 
used, as it causes mercurial disease; extraction; troublesome 
haemorrhage to be arrested by w T ashing out cavity; saturating 
cotton wool with a solution of tannin or perchloride of iron, 
and a piece of cork to cause pressure when jaws are closed. If 



DISEASES OF THE ORGANS OF DIGESTION. 331 

necessary, tie the lower jaw firmly against the upper with a 
bandage. 

Toothache from Inflammation of Pulp. — When the pulp 
has been bared, irritation may be set up by food, cold or hot 
drinks, candies, etc. 

Treatment. — Wash mouth out with a strong solution of 
tepid water and bicarbonate of potassa, and stop the tooth with 
a mixture of tinctures of aconite, belladonna, and chloroform, 
or apply chloral. If that fails, drill into pulp cavity after 
stopping. 

Toothache from Necrosis of Fangs. — The crown and neck 
of the tooth may be healthy and yet the fangs diseased. There 
may be a rheumatic irritation of the periosteum, which causes 
the tooth to feel longer than its fellows, and if pressed upon 
gives great pain. This may give rise to abscess again and again, 
which terminates in necrosis. Instead of necrosis there may 
be thickening of the fang and bony deposit. 

The use of iodide of potassa, with general attention to organs 
of digestion, may be tried ; all failing, extraction. 

Toothache from Neuralgia. — Neuralgic toothache from 
mal-nutrition, gout, rheumatism, mercury, malaria, etc., are 
very common. 

General treatment should be tried ; aconite, belladonna, nitrate 
of amyl, quinine, sumbul, and attention to the secretions. 

APHTHiE. 

This affection consists of a change or alteration or degrada- 
tion of the living matter concerned in the nutrition of the 
mucous membrane of the mouth into the disease-germ oidium 
albicans and leptothrix buccalis. It is a pure degradation of 
living matter in the mucous and sub-mucous coats, and first 
exhibits to the naked eye a point of redness, small, round, then 
effusion, which elevates the speck into a small blister or blisters ; 
they may be numerous and remain isolated, or coalesce and 
form patches; they may occur on the tongue, cheeks, gums, or 
extend down the oesophagus. 

Cause. — Anything that will depress the nutrition of the 
mucous membrane, as mal-nutrition, the germs of tubercle, 
syphilis, and poisons of mercury, lead, etc., and when once 
caused is contagious and infectious in itself, and has the faculty 
of carrying other germs with it; that is, for example, in syphi- 
litic aphthae, the oidium albicans can carry with it the germ 
syphilis. There is generally associated with aphthae great con- 
stitutional debility. 

Infantile Aphthae — Is very* apt to arise from the imperfect 
cleansing of the mouth, or the child being permitted to lie with 
the nipple in its mouth. Particles of milk lodging in the ere- 



332 DISEASES OF THE ORGANS OF DIGESTION. 

vices of the mucous membrane become sour or rancid, and give 
rise to irritation of the mucous membrane ; or it may be due 
to heated milk from over-work on the part of mother, or the 
lactiferous fluid may be bad. It may come from diseased chil- 
dren kissing each other, or diseased adults kissing healthy babes. 
Once the disease-germ is developed in the child's mouth, the 
nipple of the mother becomes similiarly affected ; vesicles form- 
ing, then cracks and fissures, filled with colonies of oidium 
albicans. 

The general health suffers. The child becomes irritable and 
restless; some fever, debility, cough, vomiting, diarrhoea, and 
general want of nutrition. 

The small white blisters become ulcers on the tongue, cheeks, 
gums, palate, tonsils; breath is foetid, and if they extend down 
there may be difficulty in swallowing; and if there be much 
debility, the case may merge into ulcerative stomatitis or can- 
crum oris. 

Treatment. — General attention to the health of both mother 
and child ; administer remedies to correct any indigestion ; 
keep bowels open with neutralizing mixture or compound 
liquorice powder ; swab or wash mouth very gently with borax 
and honey, or borax and sage-tea, or chlorate of potassa and 
glycerine, applying the same remedies to nipple, and follow- 
ing them with a thick coat of vaseline or ozone ointment. 
In the infantile form the disease-germ is readily destroyed by 
those remedies. 

In adults there is usually some prostrating disease or great 
debility, and the aphthae, or rather the oidium albicans are 
developed in great numbers between the epithelial cells of 
mucous membrane, forming dirty, diphtherial-looking mem- 
brane, the spores of the germ spreading in all directions, ren- 
dering the mucous membrane loose, soft, and friable ; here the 
use of borax and glycerine. It is necessary to use sulphite of 
soda, sixty grains to the ounce of water ; wash out three times 
a day, and at other times chlorate or permanganate of potassa ; 
besides, those or other antiseptics, such as brewers' yeast, car- 
bolic acid and tincture of iodine, as in typhoid fever, with bland, 
nutritious diet, compound tincture cinchona, mineral acids and 
alteratives. 

The Tubercular form is very common, usually associated with 
tubercular laryngitis, or bronchitis, or pulmonary phthisis. 

The Syphilitic form is recognized at once by the copper- 
colored appearance of the mucous membrane and ulcers. 

The Mercurial by the fcetor of breath and metallic appear- 
ance of the ulcers. 

In those varied forms, mouth-washes and gargles of chlorate 
potassa in infusion of golden seal, or sulphurous acid in infu- 



DISEASES OF THE ORGANS OF DIGESTION. 333 

sion of hyssop or gold thread, with general alteratives and tonics. 
With seventy-five per cent, of our population tuberculous, and 
fifty per cent, tainted with syphilis, and aphthae so common, the 
habit of kissing should be carefully guarded. Simple aphthae 
is of little moment, but when it carries with it danger of 
syphilitic contamination, it is a matter of great importance. 

INFLAMMATION OF THE MOUTH. 

Inflammation of the mouth is sometimes met with in young 
children. It occurs in three forms, confined to the mucous 
follicles, substance of the gum, or in the tissue of the cheek ; 
in no respect does it differ from aphthae, only as to its mode 
of organization. 

(1.) Follicular Stomatitis. — Inflammation of the mucous 
follicles may arise from mal-assimilation ; more generally it is 
a sequel of fevers, especially the eruptive. 

Symptoms. — Great difficulty in nursing, abundant flow of 
saliva, glands of neck and throat tender, restlessness and fever, 
loss of appetite, diarrhoea, offensive discharges, vesicles in 
mouth and tongue and fauces, vesicles burst and form ulcers, 
which are covered with dirty or yellowish sloughs. 

(2.) Ulcerative Stomatitis is simply the follicular form 
progressed on to ulceration of the gums. Here the symptoms 
are all aggravated, profuse salivation, swelling of lips and 
glands of throat ; gums become red, swollen, of a violent color, 
and covered with a layer of pulpy greyish matter. If disease 
proceeds, gums become destroyed by ulceration ; teeth become 
exposed, and are loosened ; irregular sloughing. 

(3.) Gangrenous Stomatitis, or cancrum oris. Sloughing 
phagedema of the mouth follow the above, if there is great 
debility and overcrowding. The sloughing extends over cheeks 
and gums, lips, saliva copious ; breath horribly offensive ; great 
constitutional disturbance ; complications are liable to occur. 

Treatment. — We must bear in mind the nature of stomatitis ; 
that in its first stage it differs little from aphthae in its cause, 
in its disease-germ origin, in its symptoms ; vital force is lower, 
and superadded to the oidium albicans, there are numerous 
bacteria. That in its three forms it can be communicated 
from individual by local contact, and probably by contagion 
and infection. The cause is a living poison. 

Disenfectants should be exposed in the apartment ; the mouth 
should be washed out every hour with either a solution of 
chlorate or permanganate ; the carbolic acid and tincture of 
iodine administered every hour; juice of raw meat, milk, cream 
for diet. Aphthae in debilitated children, improperly nour- 
ished, and subject to depressing influences of overcrowding, 
becomes gangrenous diarrhoea. 



334 DISEASES OF THE ORGANS OF DIGESTION. 

Since both conditions are found to depend upon the presence 
of disease-germs, and a rigid antiseptic treatment inculcated, 
we have few aggravated cases of this once terribly fatal disease. 

BUCCAL GLANDS. 

Those glands in tubercular patients are often the seat of 
inflammation and tubercular effusion. The chain of glands, 
corresponding to the molar teeth, are generally those that 
become affected. They become as large as peas, and, in very 
aggravated cases, like small marbles. 

As a general rule, they are very promptly influenced by 
iodide of potassa internally, and an ointment of phytolacca, 
iodide of potassa, and muriate of ammonia locally to the cheek 
over nights. 

The general treatment for tubercular in all cases must be 
inculcated ; and if there is any source of irritation in the mouth, 
it must be removed. 

ACUTE TONSILITIS. 

Inflammation of the tonsils is one of the most common 
affections of the mouth. One or both tonsils may become 
affected. 

The predisposing causes are weakness of organization, a 
tubercular diathesis or enervation of the glands by mercury, 
other poisons, etc. The exciting causes are cold, damp, expo- 
sure, cold drinks when body is heated, seasons of the year, as 
winter, spring, vicissitudes of temperature; common in- all 
periods of life. 

Symptoms. — Those consist in the usual languor, lassitude, 
debility, rigors, and a fever of a prett}^ high grade. The ton- 
sils and adjacent parts become sore, tender, painful, red, hot, 
and swollen. There is also great pain and difficulty in deglu- 
tition ; return of liquids through the nostrils in attempting to 
swallow ; there is pain along the eustachian tube and deaf- 
ness ; glands exude considerable mucus, so that the throat is 
filled, and gives rise to some hawking and spitting ; respiration 
may be affected ; the parotid gland at angle of jaw sympa- 
thizes ; tonsils can be seen often, if double, almost meeting at 
root of tongue. 

Its duration is from four to ten days. It may terminate in 
resolution, but apt to return on exposure ; or it may terminate 
in effusion of lymph, with thickening and induration, or in 
breaking down of lymph, abscess. If indurated or hypertro- 
phied, will alter the voice. 

Treatment. — Patient to be kept in bed; warm room; the 
administration of an emetic of lobelia and capsicum is attended 
with good results ; to be followed up with large doses of tincture 



DISEASES OF THE ORGANS OF DIGESTION. 335 

of aconite and belladonna ; mouth and throat washed out 
every hour with chlorate of potassa and tepid water ; heat to 
feet, and general treatment for fever; locally to the angle of 
the jaws, heat and moisture, poultices with mustard. Patient 
an adult, the hypodermic action pilocarpin might be tried ; it 
often breaks up most severe attacks. Its diaphoretic action is 
excellent, but it has a special action on the tonsils in stimula- 
ting them, and causing them to disgorge the inflammatory 
products with which they are loaded. If young, better to use 
the acetate of ammonia in alternation with compound tincture 
of serpentaria. Those two remedies act kindly and speedily . 
Just as soon as fever abates, begin with doses of iodide of 
potassa, ranging from five grains upwards, every three hours. 
If suppuration seems to be inevitable from the presence of 
rigors, pain changed to a throbbing one, and by the appear- 
ance of a yellow speck on tonsils to the eye, or sense of fluctua- 
tion to the touch, then let the patient inhale hot vapors of 
ammonia, poultice assiduously, and when ready for evacuation 
of the pus, administer a good, smart emetic of lobelia. In the 
straining efforts at emesis, the contents of the tonsil is freely 
discharged, and a rapid recovery takes place under good diet 
and such remedies as compound tincture cinchona and aro- 
matic sulphuric acid. If any soreness or induration remains, 
chlorate potassa for a gargle, and iodide internally. 

CHRONIC TONSILITIS. 

Once the tonsil has suffered a partial death, it is very liable 
to become irritated by very slight causes. This repeated, spring 
and fall, soon tells disastrously on the medulla oblongata, and 
the patient, after suffering a few attacks, becomes tubercular; 
so that in chronic inflammation we usually find tubercular 
deposits in the tonsils. In the chronic form there is little sore- 
ness or heat or pain, but a vast deal of effused lymph or tuber- 
cle thrown out, and as the gland is very vascular, they often 
become enormously hyperthrophied ; the enlargement being 
so great that they meet on tongue, causing thickness of speech 
and obstruction to swallowing and even to inspiration. 

In such cases, don't think of exusion, as there is danger in 
such a proceeding. Put the patient upon iodide of potassa with 
a vegetable alterative, changing the alterative weekly but not 
the iodide. Paint tonsils once or twice a week with tincture of 
iodine and iodide of potassa, equal parts, to the angle of jaw 
externally; apply every night ozone clay, which can be removed 
during the day and applied only at night. 

While pursuing this alterative and absorbent treatment, 
tonics, as quinine, mineral acids ; best of diet and everything 
done that tends to build up vital force. Give remedies a fair 



336 DISEASES OF THE ORGANS OF DIGESTION. 

trial, and there will scarcely ever be any need of surgical pro- 
ceeding. 

CANCER OF TONSIL. 

Cancer of tonsils is recognized by the diathesis, the pain, and 
when ulcerated by the fcetor. In its treatment, the brushing it 
over with the ozonized solution of chloride of chromium, destroys 
the germinal muci, which will be thrown off in a few days, 
when washes of permanganate and the usual treatment for 
Cancer resorted to. 

EXHALATIONS FROM TONSILS. 

The tonsil, like the nose, axilla, and feet, are very abun- 
dantly supplied with sebaceous glands, whose function is to 
eliminate sebaceous matter which ought to be thrown off by 
the liver. When the liver suffers depression, irritation by 
alcohol or mercury, or when it is diseased or suffers degenera- 
tion, it becomes unable to work off the carbonaceous matter 
from the blood, and the sebaceous glands have to do its work. 
Those glands of the tonsils become very active, and exhale car- 
bonaceous and other matter freely, and is one of the most com- 
mon causes of foetid breath. In the largest proportion of cases, 
it is not the teeth, nor the imperfect digestion, nor disease of 
the lung, but the liver that is the cause of fcetor of the breath. 

The proper treatment is to attend to the liver by the proper 
remedies; at the same time, mouth-washes of borax and sage 
tea, or infusion of hyssop and chlorate of potassa. An avoid- 
ance of carbonaceous food or drink, as fat, sugar, alcohol, beer. 

PAROTITIS OR MUMPS. 

A specific and highly contagious form of inflammation of 
the parotid gland. There is to be found on the tongue, mucous 
membrane of cheek, gums, saliva, a special micro-organism 
or disease-germ, which, being exhaled by the breath, is capable 
of spreading this disease by contagion and infection. This 
germ originates in the degraded living matter of our own bodies ; 
how, we cannot tell, but man is responsible for their origin or 
conditions favorable for their production and dissemination ; 
that the parotid is their favorite pasture-field, provided the 
gland is weakened in any way; for we find if we raise the stan- 
dard of vitality of that gland, the disease-germ seeks devitalized 
glands or structures analogous in character, as the mamma, 
ovaries, testes, and brain. 

In the blood of all persons affected with mumps are to be 
found an abundance of the minute organisms, for the most part 
spherical, but partly prolonged and in the form of mobile rods. 

Symptoms. — Usually a period of incubation, with the ordi- 



t 

DISEASES OF THE ORGANS OF DIGESTION. 337 

nary indications of debility, followed by chilliness and fever, 
with pain in head, back, and limbs; pain and swelling over one 
or both parotids, stiffness of jaw, some soreness in swallowing. 
Fever and inflammation reaches its height in four days and 
then declines, occupying about a week in all. If any stimu- 
lant is applied to the parotid, germs leave and cause inflamma- 
tion of mamma, testicle, etc. 

Treatment. — Rest in bed; aconite and belladonna freely; 
dry covering over angle of jaw, but no heat or stimulants: warm 
foot-bath, heat to feet, open bowels; diet, warm beef tea. milk. 
To destroy germs in blood, solution of acetate of ammonia, or 
chlorate and permanganate of potassa. If there is much debility, 
quinine. 

Inflammation of the Parotid may take place from cold, 
disease-germs in the blood, as in scarlet fever, small-pox, tuber- 
cular, syphilis, mercury: and it then demands a very different 
form of treatment. 

During the acute stage, arterial sedatives and hot poultices, 
with general alterative and tonic treatment as to cause; and if 
the gland becomes enlarged, the ozonized clay is a remarkable 
resolvent, even in tubercular cases; or clay on during the day 
and poultices at night. Iodide of potassa, with phytolacca, 
iris versicolor, saxifraga, are important internal remedies. 

PHARYNGITIS. 

Inflammation of the pharynx is a very rare form of disease. 
We meet with it occasionally in terribly broken-down condi- 
tions, where the vital forces are at a low ebb, mal-nutrition and 
mal-assimilation extreme, as we often find it in the degrading 
haunts of poverty and vice; and when it occurs, it is mostly 
erysipelatous or bacterial, and is attended with great prostration, 
low fever, and difficulty in swallowing. Death takes place from 
exhaustion. 

Our remedies, then, are to get the patient into a better atmos- 
phere; abundance of antiseptics or disinfectants around. Ad- 
minister quinine freely: give brewers' yeast in tepid milk every 
three hours. Diet, beef tea, with barley, raw eggs. 

Syphilitic Ulceration of fauces and pharynx often causes 
difficulty. The treatment involves general principles. 

Elongation of the Uvula may result from chronic inflam- 
mation, or a relaxed condition of the fauces due to repeated 
colds. The palate or curtain drops, and gives rise to a trouble- 
some tickling cough, with an occasional inclination to vomit; 
usually worse when he lies down. Astringent washes, as cold 
infusions of golden seal, gold thread, alum in sage tea, cold, 
brushing over with perchloride of iron. If all means fail, snip 
off about two-thirds of its length. 

34 



338 DISEASES OF THE ORGANS OF DIGESTION. 

DYSPHAGIA. 

Difficulty of deglutition. Difficulty of swallowing is a symp- 
tom of great prominence in disease of the pharynx and oesopha- 
gus, as inflammation, ulceration, stricture, spasmodic contrac- 
tions, polypus, cancer. It may arise from glossitis, acute or 
chronic tonsilitis, croup, diphtheria, inflammation and abscess, 
paralysis of muscles of deglutition in various diseases, malignant 
and tubercular, or syphilitic ulceration about epiglottis, fauces. 
Presence of tumors, spasm of pharynx and oesophagus, as in 
hydrophobia; inflammation, ulceration, or oedema of larynx. 

RETROPHARYNGEAL ABSCESS. 

An abscess the result of acute or chronic inflammation of 
the loose areolar tissue, between the posterior wall of pharynx 
and muscles on anterior part of the spine; often associated with 
or dependent on the tubercular diathesis or syphilitic taint. 

Symptoms.— Rigors, fever, soreness of throat, restlessness, 
nausea, with derangement of brain, lungs, and heart; difficulty 
in breathing and swallowing ; a fixed and retracted state of head ; 
rigidity of muscles at back and neck ; more or less locked state 
of jaws; painful, difficult, and drawling articulation. As pain- 
ful deglutition increases, solids are refused ; liquids regurgitate 
through nose; spasmodic efforts at swallowing on depressing 
the tongue and examining fauces; a firm and projecting tumor 
is felt just behind the base of the tongue. Death often results 
from convulsions, coma, from tumor pressing pharynx forwards 
on epiglottis and rimagiottis, causing suffocation ; from abscess 
suddenly bursting, pus finding its way into the trachea. 

Treatment. — General treatment for tuberculae or syphilis ; 
bland, nourishing food and drink ; as soon as pus can be 
detected in any quantity, puncture pressing head forward, so 
as to facilitate escape of pus by mouth. 

(ESOPHAGITIS. 

Inflammation of the oesophagus is very rare. It may, how- 
ever, occur as the result of erysipelas in a tubercular or syphi- 
litic patient. If the germs of variola or scarlatina do not find 
their way to the skin, they may appear here. The use of 
alcohol, irritating drugs, acrid poisons may also cause it. 

Symptoms. — Difficulty of swallowing, fever, burning sore- 
ness along the tract of the oesophagus, shooting pains from 
throat to between shoulders, fits of coughing, hiccough, consti- 
pation, etc. Ulceration, gangrene may be the result. 

Remedies are to consist of mucilaginous drinks, as flaxseed 
tea, gum-arabic-water, milk or cream; suppositories of opium 
every two hours; tincture of green root of gelseminum and 



DISEASES OF THE ORGANS OF DIGESTION. 339 

morphia in small but often-repeated doses; fly blister front 
and back for six hours ; strips of three inches wide and twelve 
inches long, followed with hot poultices and opium. If no 
improvement, try hypodermic injections, one-third of a grain 
of pilocarpin ; otherwise, treat upon general principles. 

Simple ulceration of the oesophagus is attended with great 
difficulty in swallowing; sometimes so great that deglutition is 
impossible. There is usually pain at stomach, or top of ster- 
num, or between shoulders; nausea, anxiety, and debility; ulcer- 
ation often extensive. 

An effort to support strength by nutritious enema, juice of 
raw meat, raw eggs, milk ; perfect quiet, even talking forbidden. 
The two blisters applied as above, smeared with croton oil, 
followed by hot poultices, changed frequently, so as to leave 
free suppurating sores ; then glycerine and chlorate of potassa 
should be tried, quinine and opium, and gradually alteratives, 
with iodide of potassa. 

(ESOPHAGISM. 

A purely nervous disorder, consisting in some weakness 
of the cervical sympathetic ; common in women ; causes are 
obscure. 

Symptoms. — Individual imagines she has swallowed some- 
thing — a pin, fish-bone, her artificial teeth, or some hard sub- 
stance, and it is sticking in the oesophagus. Irritation increases 
as the delusion is nourished. There is difficulty in swallow- 
ing, owing to constriction of the superior, middle, or inferior 
constrictor muscles b} 7 the fancied irritation acting on their 
nerves. Symptoms are so genuine as to deceive medical experts. 

Treatment. — It is well to make a careful investigation or 
search by fingers, bougie, laryngoscope, which fails to detect 
any substance ; or perhaps her teeth may be found under a 
pillow, when symptoms instantly disappear. The treatment 
should be a general course of nerve tonics, as quinine, bromide, 
sumbul, etc. If case is stubborn, try the same treatment as for 
hysteria or anaemia of spinal cord. 

STBICTUEE OF THE (ESOPHAGUS. 

Stricture of the oesophagus may be met with either in a 
spasmodic or organic form. In the former it comes and 
goes ; in the latter there is effusion of lymph and permanent 
obstruction. The oesophagus being made up of circular mus- 
cular rings, like the urethra and bronchi, and each being sup- 
plied with sentient nerves, renders it very susceptible of the 
slightest irritation, which gives rise to contraction, and these 
being repeated, give rise to thickening. 

Spasmodic Stricture. — That which is not permanent, but 



340 DISEASES OF THE ORGANS OF DIGESTION. 

comes and goes; may come on in two ways. There may be 
some weakness or irritation of the cervical nerves that supply 
the oesophagus, when in suddenly swallowing a cold fluid, which 
acts as a depressent to the points of the nerves in the muscular 
rings, a sudden contraction takes place. It comes on generally 
in swallowing a fluid, for fluids are more difficult to swallow 
than solids. In the act of swallowing a liquid, all the rings of 
the oesophagus are brought into active requisition ; whereas, in 
swallowing a solid well-masticated it will slip down without a 
movement. In the other case there may be no central nervous 
weakness, but may be brought on suddenly by gulping down 
large draughts of ice- water, cold beer, and other cold drinks 
in hot weather. The coldness and haste produce the shock, 
followed by contraction, which when once induced is likely to 
be repeated, if the same cause is brought to bear. It is very 
common in beer-drinkers and young ladies swallowing large 
quantities of ices, iced drinks, ice cream. 

Symptoms. — Difficulty in swallowing ; at first confined to 
fluids, usually cold ; then it extends to warm drinks and solid 
food ; but the difficulty is not always ; it comes on by spells — 
often a sense of fullness and choking under the influence of 
excitement. It cannot be confounded with permanent stricture, 
because the difficulty of swallowing is only now and again, 
and a bougie will pass down without a particle of obstruction. 

Treatment. — In the treatment of spasmodic stricture, the 
greatest care should be exercised in eating and drinking; food 
to be bland and nutritious, well-masticated, and swallowed 
slowly; iced drinks, as iced lemonade, ice cream, and cold 
food or drink forbidden. All liquids should be taken slowly. 
Otherwise, shower baths, nourishing diet, flannel clothing, such 
drugs as quinine, irou, sumbul, lobelia, general tonics, and 
alteratives. If not attended to, it may lead to the organic form. 

Organic Stricture is a condition in which lymph is effused 
in or on the circular muscular fibres of the oesophagus ; thick- 
ening produced; it may involve the entire ring clear round, or 
only a part, and forms a permanent obstruction to the descent 
of solids, and often liquids. The effusion may be mere lymph, 
or even cartilage. 

The cause is some irritation, as spasmodic stricture or the 
swallowing of some irritant, which gives rise to the effusion of 
lymph. 

Symptoms. — Vomiting after taking food which descends 
to a point, and apparently sticks, and is thus rejected; or if the 
diet is very bland or soft, or the drink mucilaginous, it may 
pass through the obstruction. If case is seen here, and proper 
treatment inculcated, a cure may be affected. But if neglected, 
after the end of six or eight months the inability to swallow 



DISEASES OF THE ORGANS OF DIGESTION. 341 

becomes greater, until little can be swallowed. Then emacia- 
tion, debility takes place, and increases rapidly. The stricture 
can be felt, its size and shape well made out by bougie. If not 
cured, starvation takes place in spite of nutrient enemata. 

Treatment. — The seat or location of the stricture can readily 
be made out by the feeling of obstruction and bougie. When 
that is ascertained, paint over a space of four inches square over 
it; paint with cantharidis collodion to remove cuticle; then 
paint with croton oil, and over all the irritating plaster, spread 
fresh daily and applied ; encourage free suppuration over site. 
Then iodide of potassa in doses ranging from five to fifteen 
grains, with same quantity of carbonate of ammonia in some 
vegetable alterative. Three times a week bougies, well warmed 
and oiled, should be introduced. Begin with a small one that 
passes easily, and gradually increase their size, larger and 
larger, till case is cured. The diet should be of the most 
nutritious kind — juice of meat, raw eggs, cream. This course 
of treatment must be carried on for at least a year after the 
patient is well. 

Cancer of the (Esophagus. — Very apt to follow stricture. 
The cancer germs may be deposited the entire length of the 
gullet, but more generally on the affected rings in stricture. 
In may assume the medullary, scirrhus, or epithelial form. 

It is easily recognized by the cachexia, by the pain, anterior 
and posterior, by the burning soreness in the canal, cough, hic- 
cough, cutting pain in throat, ears, usually nausea. All the 
symptoms of permanent stricture, as difficulty of swallowing, 
perfect obstruction to the descent of food ; generally a pouch 
forms above obstruction, in which food lodges ; wasting, debility, 
prostration. 

Treatment of no avail ; relieve pain by hypodermic injec- 
tions of morphia, and, if possible, introduce a tube through or 
over the cancerous mass every four hours, and inject juice of 
raw meat, port wine, and raw eggs. 

HAEMORRHAGE FROM THE STOMACH. 

Vomiting of blood from the stomach may be due to a large 
variety of causes. It may be a symptom of acute inflammation, 
of yellow fever, of abdominal disease, of ulcer in the stomach, 
of cancer, of diseased liver, scurvy or purpura, or vicarious 
menstruation. The vomited blood may be a pure red, mixed 
with the secretion of the stomach, or it may be dark, frothy, 
or most frequently it is like coffee grounds, or black, so changed 
by the acids of the stomach. 

Treatment. — No food; recumbent posture; try small doses 
of common salt; heat over stomach; tincture of green root 
gelseminum is our best drug, and repeat; or, try gallic acid; 



342 DISEASES OF THE ORGANS OF DIGESTION. 

for thirst, small pieces of ice, or wash out mouth with plain 
water; those failing, aromatic sulphuric acid and quinine. 
Nourish carefully with beef juice, raw eggs, and enemata of 
beef tea. 

ACUTE INFLAMMATION OF THE STOMACH. 

Gastritis or acute inflammation of the stomach is a very fatal 
affection, as the stomach is a very vital organ. 

Causes. — The ordinary causes are the introduction of irri- 
tating agents into the stomach, such as poisons, arsenic, caustics, 
mercury, acids, emetics, whisky, and other irritants; or it may 
be caused by blood poisons or disease-germs, as in yellow and 
puerperal fevers; or by inflammation spreading from other 
parts, as in inflammation of the uterus and peritoneal coat; it 
often spreads to or involves the stomach. 

Symptoms. — Nausea and vomiting; burning soreness or raw- 
ness in the stomach, accompanied with a pricking or lancina- 
ting pain, very tender to slightest touch, or even pressure of 
bed-clothes; intense thirst; great desire for cold drinks, which 
when swallowed, are almost immediately rejected; tongue at 
first may be furred or coated white, with red tip and edges, or 
in streaks, and subsequently it assumes a raw-beef appearance, 
smooth and glassy; and if the blood is affected, dark at the 
root. The matter vomited at first, is usually serous, or mucous, 
or biliary, then becomes greenish, latterly like coffee grounds, 
or black, which is simply blood changed by the action of the 
acids of the stomach. There is a generally tympanitic condi- 
tion of the abdomen, and patient lies on back with knees drawn 
up and head and shoulders elevated, so as to keep the abdom- 
inal muscles from pressing the stomach. Temperature is very 
high ; pulse frequent, small and wiry; respiration frequent and 
short; features pinched and sharp-pointed; constipation; loathing 
of food and disgust of warm drinks; urine scanty, high-colored; 
its duration, about a week. If not very carefully and energetically 
managed, death is very liable to take place from exhaustion, 
or suddenly from gangrene. The best we can obtain is to run 
it into chronic gastritis. 

Treatment. — The patient must be kept as quiet as possible 
in recumbent posture in bed; weight of bed-clothes kept off 
by a cradle; heat to feet; sponging body thrice daily; mustard- 
plaster poultices over stomach, followed by hot poultices of gly- 
cerine, flaxseed, and opium; no drink allowed; patient can 
take water or ice in mouth, but must not swallow much, if any; 
nothing to enable the stomach to contract. Small, but oft- 
repeated doses of tincture of green root gelseminum, in alter- 
nation with a solution of morphia. The two remedies adminis- 
tered on and on every half hour till narcotism is induced, which 



DISEASES OF THE ORGANS OP DIGESTION. 343 

condition should be continued for ten or twelve hours, and 
patient kept on right side. If successful with narcotism, then 
continue same two remedies every three or four hours for a 
few days; give no food, a little mucilaginous drink, as gum- 
arabic water or marshmallow tea; nutritive enemata every 
three hours. The point to be aimed at is narcotism, during 
which inflammatory action ceases. 

If a complication of other diseases, still this point holds good. 
The idiosyncrasy that often exists to the action of opium or 
morphia, is entirely overcome by the gelseminum. If success- 
ful, be very cautious about beginning diet: milk and pepsin, 
beef tea and pepsin, white of egg and pepsin, juice of raw beef. 

CHRONIC INFLAMMATION OE THE STOMACH. 

A low grade of irritatior? in the various coats of the stomach. 

It may follow an acute attack, or may come on from the 
introduction of irritants into the stomach, as arsenic, mercury, 
whisky, etc.; swallowing immoderately iced drinks; bolting 
ice-cream after a hearty meal, thereby suspending digestion and 
devitalizing the stomach. In ladies, belts, or other articles of 
dress irritating stomach; in men, from dispensing with sus- 
penders, wearing belts; and mechanical occupations, pressing 
on stomach; also, direct violence, and other like causes. 

Symptoms. — The symptoms of chronic inflammation of the 
stomach involve all that are present in the various forms of dys- 
pepsia, as heartburn, water-brash, eructations of gas or liquids, 
gastrodynia, slow or imperfect digestion, with headache; besides, 
the tongue is red at tip and edges, with a white coat in the 
centre; there is pain in the stomach, aggravated by pressure 
or the clothes ; disordered bowels ; often a craving for food, but 
only as mall portion can be taken without producing oppression 
and vomiting. 

Chronic gastritis is essentially stubborn. It may exist many 
years, even in a mild or aggravated form, but is very apt to 
terminate in thickening or induration of its coats, narrowing 
of the pylorus, or ulceration, perhaps going on to perforation. 

Treatment. — In this affection, rest, daily bathing, bowels 
opened by enema of some soup ; flannel clothing. A suppura- 
ting sore, about four square inches, should be maintained over 
region of stomach, until a few months after recovery. The diet 
should consist of the juice of raw beef, milk, with lime-water 
or bicarbonate of potassa, arrow root, milk toast, boiled fish, 
chicken, oatmeal mush ; three meals per day, pepsin to follow 
each in a suitable dose to digest without making any demand 
on stomach for digestion ; drinking fluids to be forbidden. 

After attending to those preliminary points, our next and 
main object is to increase the vitalizing tonicity of the stomach. 



344 DISEASES OF THE ORGANS OF DIGESTION. 

For this purpose, compound tincture of cinchona, four ounces ; 
aromatic sulphuric acid, one ounce; one teaspoonful every four 
hours in water, or if that does not operate well, use infusion 
of golden seal, from a tablespoonful to three every four hours ; 
collinsonia, gentian, columbo, or other remedies laid down 
under the head of Dyspepsia. If there is much burning, sore- 
ness, or rawness, use gelseminum and quinine freely, or gel- 
seminum and chlorate of potassa. Once rid of pain, with ten- 
derness on pressure, and the red tip and edged tongue, then a 
general course of vegetable alteratives and tonics, with more 
extended and varied diet. 

Effusion of Lymph — Which produces thickening or indu- 
ration of the walls of the stomach, has a tendency to interfere 
with the normal vermicular motions of the stomach. It is 
generally effused in the sub-mucous and muscular coats, and 
in some cases is quite thick. 

Induration of the Pylorus — Is usually due to the same 
cause, only that the lymph is more thoroughly organized into 
fibrous tissue, which forms a dense deposit about the pyloric 
portion of stomach. As a result, there is stricture, with dila- 
tation of stomach and hypertrophy of its muscular coat. 

Symptmos — Of thickening by lymph and induration of any 
part, but more especially at the pylorus, are quite numerous; 
generally the induration can be felt through the abdominal 
walls. There are present all the symptoms of indigestion, with 
considerable pain, ranging over a long period. There is also great 
emaciation and progressive debility, water-brash, nausea, and 
constijDation ; mental depression ; appetite often ravenous, but 
food creates great distress and vomiting; vomited matters are 
loaded with sarcinse or torulse; food is rejected only partially 
digested; disturbed sleep; prostration; death from inanition. 
By a strict attention to diet and remedies, many cases make a 
good recovery. 

Treatment. — Pretty near the same as for Chronic Gastritis. 
Irritating plaster over stomach ; diet to be followed by pepsin, 
bowels opened with enemata; warm clothing, and general altera- 
tives and tonics. 

Dilatation of the Stomach. — Generally due to induration 
of the pylorus and thickening, which causes contraction, so that 
the food cannot pass into duodenum. It is usually progressive; 
goes on slowly and steadily until stomach becomes enormously 
distended. Cases occur in beer-drinkers without any cause but 
the inordinate use of large quantities of fluid. 

Symptoms. — A voracious appetite, with all the symptoms 
of indigestion, as heartburn, water-brash, flatulence, constipa- 
tion, vomiting. In the ejected matter can be found immense 
quantities of the sarcinse ventriculi and yeast plant. Those 



DISEASES OF THE ORGANS OF DIGESTION. 345 

organisms probably result from the degraded living matter of 
the mucous membrane, and the yeast fungus from fermentation, 
from food being long delayed in the stomach. 

Treatment. — This must be upon general principles — an 
abundance of food, light and easily digested; the micro-organ- 
ism to be destroyed by chloride of lime, same as in gastric 
catarrh, and the case treated as one of general dyspepsia by 
vegetable alteratives and tonics. 

Gastric Ulcer. — The final termination of chronic inflamma- 
tion of the stomach into effusion of lymph, is the breaking 
down of that lymph into pus, and the formation of a gastric 
ulcer. Rigors, with the history of the case, is often all we have 
to guide us. The pus, as a general rule, evacuates itself into 
the stomach, and finds its way into the bowels, leaving in the 
stomach an ulcer that is round, looks as if scooped or punched 
out of mucous membrane, and mostly found at or near the 
pyloric opening. May prove fatal by haemorrhage, perforation, 
or exhaustion. 

Symptoms very variable; pain in the stomach and over 
lower dorsal vertebrae ; increased by food ; the tenderness in or 
over the region of the stomach circumscribed to a small spot 
or area, and is increased by any warm drink or saccharine 
matter; violent aortic pulsation; all the symptoms of indi- 
gestion ; eructations of sour fluids, nausea, and vomiting ; great 
prostration and loss of flesh. In favorable cases ulcer heals, 
and there is complete recovery; amenorrhcea in women. If 
ulcer eats into a large vessel, there is often haematemesis. If 
a large meal is taken, or emetics given, there may be perfora- 
tion, with profound prostration, collapse, and death. 

Treatment. — Pain must be relieved with morphia in an 
infusion of bayberry ; poultices locally, and the greatest care 
as to diet, only small quantities of liquid food given ; all indi- 
gestible substances should be carefully avoided. At first milk 
and lime-water; subsequently boiled fish, poultry, and lightest 
kind of diet. Special remedies to act on ulcer — bayberry, golden 
seal, mineral acids, and sulphate of quinine. 

A cautious use of vegetable alteratives and tonics, keeping 
bowels open with enemata, and all straining efforts must be 
avoided. Other symptoms treated on general principles. 

In rare cases, gastric ulcer terminates in an adhesion of the 
peritoneal coat of the stomach to the peritoneal coat of the 
abdomen, the ulcer eroding or eating its way through the 
abdominal walls, and forms a fistula, with an opening exter- 
nally. In another class of cases, the irritation wears out or 
exhausts the vital force so much that the cancer-germ is devel- 
oped, and we have 

Cancer of the Stomach, occuring most frequently in the 



346 



DISEASES OF THE ORGANS OF DIGESTION. 



position where lymph was effused at the pyloric opening of 
the stomach, or else in the space or curvature between the 
cardiac and pyloric openings. It is usually of the medullary, 
scirrhus, or colloid variety. 

The long-continued irritation of chronic inflammation, effu- 
sion of lymph, thickening, breaHng down of lymph into pus 
not only create the cancerous cachexia, but the local partial 
death in the stomach permits of a deposit of the germs. 

Symptoms. — In addition to all those of dyspepsia, there is 
the cancerous cachexia, pain in the stomach of a burning, lan- 
cinating, or gnawing character, radiating from front to back, 
increased by food and pressure ; retraction of abdominal walls, 
eructations of foetid gas, resembling carburetted hydrogen gas ; 
nausea, vomiting of glairy mucus, or of a bloody sanious fluid, 
or dark grumous matter resembling coffee grounds, but loaded 
with cancer-germs. If the cancerous deposit is at the cardiac 
opening, a pouch is likely to form at the lower end of the 
oesophagus, in which the food accumulates, returning undi- 
gested, together with mucus. If the cancerous deposit is near 
the pylorus, food is retained longer and more changed ; consti- 
pation, debility, emaciation, restlessness, anxiety. If cancerous 
mass lies over descending aorta, it may have a pulsating feel. 
If it is any size, and is medullary or scirrhus, it can readily be 
felt by the hand. 

Before terminating in death it may terminate in perforation, 
and contents of stomach escape into peritoneal cavity, or there 
may be adhesion between stomach and abdominal walls, and 
fistulous openings form externally, or adhesions may take place 
between stomach and duodenum, diaphragm, lungs, pericar- 
dium. The duration of cancer of the stomach is from one to 
two years. 

Treatment. — General treatment for cancer; open two large 
sores between shoulders ; encourage free suppuration with croton 
oil and poultices ; give opium and conium freely to alleviate 
pain ; apply belladonna plaster over stomach ; use ozonized 
glycerine or water internally. As soon as free suppuration is 
established between shoulders remove belladonna from stomach, 
and bind over it ozonized clay half an inch thick ; don't cause 
redness ; moisten or change every two or three days. Don't spare 
antiseptics, lime-water and milk, yeast and milk, chlorate or 
permanganate of potassa occasionally. If clay irritates locally, 
apply solution of sulphate of manganese; when irritation ceases, 
re-apply the clay ; the cancer alterative pushed carefully as 
can be borne. Apparently hopeless, but many cases recover 
under the antiseptic treatment. In all cases there must be 
absolute freedom from pain while pursuing the above course. 



DISEASES OF THE ORGANS OF DIGESTION. 347 

DYSPEPSIA, OR INDIGESTION. 

Anything that interferes with the healthy action of the 
stomach, brain, or bowels, may give rise to indigestion. Food 
is digested in the stomach during the day, when the patient is 
awake, and during the night, when asleep, in the bowels; so that 
indigestion must be divided into two forms — gastric and intes- 
tinal. The indigestion, or failure on the part of the stomach to 
digest, takes place immediately after a meal, and continues for 
two, four, or more hours according to the gravity of the disease, 
or kind or quality of food introduced ; whereas, in intestinal 
or bowel dyspepsia, the uneasiness or symptoms of indigestion 
do not commence for several honrs after eating. In the stomach, 
the food after being slowly and perfectly masticated, and incor- 
porated with the secretion of the parotid and other glands of 
the mouth, is subjected to the action of the gastric juice, a 
powerful solvent, being made up of a substance called pepsin. 
In the bowels, the digested food or chyme, is subjected to the 
action of the pancreatic secretion, (a gland almost immaculate, 
enjoying a freedom from disease most remarkable,) which emul- 
sifies the fat, starch, and other products, rendering them fit to 
become proper constituents of nutrition. The process of healthy 
digestion is easy, speedy, and complete; there can be no excess of 
it, for food cannot be too quickly and completely converted into 
blood ; whereas, indigestion is slow, painful, and imperfect. 

Painful, from a slight uneasiness, to pain, or actual torture ; 
slow, when the stomach fails to digest in the ordinary time, and 
chemical decomposition or change takes place ; defective, when 
the food is either altered, or fermented, or decomposed, or formed 
into vegetable germs, like the yeast plant. 

Indigestion is divided into numerous forms or varieties, 
according as one or more symptoms predominate. 

It is called Simple, when there is loss of appetite, pain, weight, 
fulness or oppression about the stomach after meals ; flatulence, 
nausea, vomiting, constipation or diarrhoea, coated tongue and 
foetid breath, with headache, palpitation, heartburn, water- 
brash, hypochondriasis. 

It is called Slow Digestion, when there is a deficient secretion 
of gastric juice; a feeling of fullness and distension at the 
pit of stomach, with the other symptoms. 

It is called Painful, when gastralgia and heartburn are the 
prevailing indications. 

Wind Dyspepsia, when flatulence, eructations of gas, and acid 
water, as water-brash or pyrosis ; there is usually gastrodynia, 
or stomach-ache. 

It is termed Boulimic Dyspepsia, when, with the ordinary 



348 DISEASES OF THE ORGANS OF DIGESTION. 

symptoms, there is an excessive hunger or craving for food, and 
even not appeased by large quantities of food. 

Nervous dyspepsia, when there is a nervous temperament, white 
face, sharp features, emaciation, phosphates and chlorides in 
urine ; all or most of the symptoms are present, but especially 
headache, like a band or scalp flying off, and hypochondriasis 
a decided and prominent symptom, etc. 

Causes. — The causes are not only numerous but varied, and 
embrace every derangement and lack of tone in any organ, or 
of the entire body. Hurried eating, with imperfect mastication 
from whatever cause; improper food; drinking of fluids at 
meals, or the use of iced or cold drinks or food, highly depres- 
sing to stomach which arrest digestion ; want of exercise ; mental 
anxiety; strain on mental powers by study or struggle for exis- 
tence ; general debility, or nervous exhaustion ; use of whisky, 
beer, tobacco, and drugs ; excessive drinking, especially cold 
drinks ; diseases of the blood ; and often due to reflex causes, 
as diseases of the liver, spleen, lungs, heart, kidneys, and to 
diseases of the nervous system generally. There is, so to speak, 
an endless chain of sympathetic and other causes. 

Symptoms — Are very variable in their nature and severity. 
Loss of appetite, pain, weight, fullness at or about the stomach 
after eating; acidity, flatulence, eructations, nausea, vomiting, 
pyrosis, tightness, heartburn, oppression, wearing cramp, lan- 
guor, debility, giddiness, with headache, frontal, or like a band 
round head, — a sensation as if there was a movement of the 
ground ; constipation most common ; still, there might be diar- 
rhoea ; tongue coated white or brown, or if intestinal, buff coat, 
with transverse fissures ; foetid breath; palpitation; pains in loins 
or limbs ; often cough ; liver very torpid ; eyes tinged with bile ; 
urine scanty, high-colored, and deposits phosphates and chlo- 
rides ; skin dry, contracted ; the brain is often seriously affected, 
both through reflex action, want of nutrition, and otherwise ; 
so that hypochondriasis is always present in either a mild or 
aggravated form. 

A look at the physiology of the stomach will satisfy anyone 
of the existence of an immense nervous connection — the very 
secretion of the gastric juice being a nervous act — for there is 
no gastric juice in a healthy stomach until the stimulus of 
food is impressed upon the gastric nerves, which is carried to 
the brain, and if that organ is healthy, gastric juice will be 
thrown out. The ultimate relation of the stomach with the 
great sympathetic, and the intimate union that exists between 
the stomach and other organs, cause non-sentient nerves to 
become highly sensitive. The abdominal plexuses of sympa- 
thetic nerves always play an important part in the production 
of indigestion. 



DISEASES OF THE ORGANS OF DIGESTION. 349 

Treatment. — In all its forms, there should be an avoidance 
of all care worry, and anxiety, study, or any mental strain. A 
vigorous brain is of essential importance, and an easy sympa- 
thetic soul of great moment. Every drain upon the nervous 
system must be blocked off; no over-work, nor care, nor sexual 
excesses. Pure blood is also important; and active, but not 
fatiguing exercise in the open air; daily bathing; if the cold 
douche or shower-bath can be borne, it is best, to be followed by 
friction and flannel clothing; a diet highly nutritious but light, 
should be laid down, consisting of broiled tenderloin steak or 
chicken, soft-boiled eggs, boiled fish, toast buttered, oatmeal 
mush, roasted potatoes, ripe fruit, mocha coffee. 

Veal, pork, salt or corned meats or fish, fried or boiled meat, 
all slop, as soups, pastry, pies, nuts, sweets, cabbage, tea, tobacco, 
alcohol, or all fermented liquors except Bass' old ale, which is 
superior to extract of malt, should be rigidly forbidden. 

Another important point is slow eating, thorough mastica- 
tion; no fluids, warm diet, perfect regularity in eating, sleeping, 
and in a daily movement of the bowels, and in perfect rest to 
stomach between meals; no nibbling, or odd snaps, or luuches. 
Not more than three meals per day, with proper intervals 
between. Bowels to be opened with enemata daily every morn- 
ing after breakfast. 

Special symptoms must be relieved or palliated, in order to 
give relief, until a cure is affected. 

The most valuable remedy in dyspepsia is a healthy condi- 
tion of the mouth and teeth, and thorough mastication of the 
food. We all eat too hurriedly. There is too little mastication, 
not a proper admixture of the salivary secretion ; so that there 
is crammed into most stomachs a mass of inadequately crushed 
or undivided solid matter, which acts as a mechanical irritant, 
sets up disease. Eating quickly, filling the stomach with indi- 
gestible material, unprepared food, renders it incapable of recov- 
ering its tone. All animals intended to feed hurriedly have 
the powers of rumination, or are provided with gizzards. Man 
is not so furnished, and it is fair to assume he was made to eat 
slowly. Hurried meals are highly mischievous. Then there 
should be rest, for a considerable time after meals, of mind 
and body; but, on no consideration, sleep. To sleep after meals 
is the worst aggravation a weak stomach can receive. During 
sleep, digestion in the stomach is, to a certain extent, suspended. 

For the Relief of Eructations and Vomiting. — One of our best 
remedies to effectually relieve this condition is pepsin. It should 
be administered with or at the meal. Its use causes little 
demand to be made upon the stomach for its digestive secre- 
tion, and artificial digestion, promptly carried out, precludes 
the possibility of either eructation or vomiting. There is no 



350 DISEASES OF THE ORGANS OP DIGESTION. 

drug to equal it, as it gives vitality to a weak organ by giving 
rest. The digestive powers are assisted, and the food which, 
in other cases, ferments and irritates, because undigested, readily 
becomes assimilated, because it is now digested. Some think 
it best to give the pepsin a little while before meals, so as to 
afford it some time to combine with the existing condition 
of the stomach, and produce a more natural effect upon the 
food when swallowed, after being acted on by the salivary 
secretion. 

The idea is to give the stomach rest, and promote the forma- 
tion of peptone ; and as soon as normal vigor is acquired, the 
organ will soon respond to the production of its natural fluids. 
It is undoubtedly a valuable agent, and no one can fail to pre- 
pare it from the formula we have laid down. 

The use of alkalies in the treatment of dyspepsia, should, as 
far as possible, be discouraged, as they tend to weaken the 
mucous coat of the stomach, and give rise to catarrh. Perhaps 
the most innocent alkali would be one teaspoonful of lime- 
water to half a tumblerful of milk, or five grains of bicarbonate 
of potassa to the same quantity of milk, once, twice, or even 
thrice daily. 

For the Relief of Gastrodynia or Stomach Cramp. — As a rule 
this form of pain comes on following a meal. It is of the same 
character as neuralgia; it is the gastric nerves crying for more 
nutrition — something to vitalize them. 

The various preparations of bismuth will relieve this pain, 
but their efficacy in other respects is not good. We witness 
their baneful effects in ladies who use it as a lace powder or in 
cosmetics, and to introduce this deadening, benumbing drug 
directly into the stomach is reprehensible if any other remedy 
can be procured. 

Capsicum or white mustard seeds, especially the former, is 
an excellent remedy, a good stimulant, does not irritate like 
black pepper, and its use affords almost instant relief. A good 
form is the compound tincture of myrrh, from half to one tea- 
spoonful after meals in warm coffee. Half or drop doses of 
dilute hydrocyanic acid act well, and being an ingredient of 
normal gastric juice, it could be added to the pepsin. A solu- 
tion of quinine in aromatic sulphuric acid is also of utility ; 
mineral acids, carbolic acid and tincture iodine ; warm plas- 
ters, as hemlock or belladonna plaster, over stomach. 

For the Relief of Pyrosis or Water-Brash. — To mention acidity 
is equivalent to rushing for an alkali, but a bitter will answer 
better. Still, patients will persist in their use on account of the 
immediate relief they afford. 

Glycerine added to milk ; one tablespoonful to half tumbler- 
ful, and taken after meals, relieves flatulence, acidity, pyrosis, or 



DISEASES OF THE ORGANS OF DIGESTION. 351 

water-brash. Usually it is speedily and completely successful, 
as it prevents fermentation and putrefaction. Although gly- 
cerine prevents putrefaction of nitrogenous substances, it does 
not prevent the digestive action of pepsin and hydrochloric 
acid ; hence, while it prevents the formation of acids, checks 
fermentation, it in no way hinders digestion. 

For the Relief of Gastralgia or Heartburn. — Keject alkalies and 
try nitric acid in compound tincture of cinchona, or dilute 
nitro-muriatic acid. If these fail, use hydrocyanic acid dilute. 
If that does not afford relief, steep gentian and horse-radish in 
good whisky enough to cover, and use in tablespoonful doses ; 
or nux vomica in fluid extract of columbo or cascarilla. 

In the event of such remedies not affording relief, then lime- 
water and milk, or bicarbonate of potassa in milk. Take it 
all in all, it is doubtful if we have a better and more diversified 
remedy in indigestion than the white mustard seed for all the 
symptoms, for heartburn, cramp, wind. The white mustard 
seed should be taken whole in gruel or water, or mucilage, in 
doses of from one to two teaspoonfuls one hour before meals. 
When it passes into the stomach, it yields a peculiar principle 
through its rind, for it is not digested, but passed whole by 
the bowels. This substance strengthens and invigorates the 
stomach, the liver, and the entire alimentary tract. Their use 
can be persevered with for many months. The longer they are 
used the better digestion becomes,, always improving. A good 
rule for the dose is the state of the bowels — -just enough before 
each meal to give one or two evacuations per day. They are 
invigorating, and give an extraordinary amount of tonicity. 

The general treatment of dyspepsia, like all other chronic 
diseases, is to be based upon a general vegetable alterative and 
tonic course, administering tonics in solution half or one hour 
before meals, and the alteratives two hours after, or some little 
time after food is supposed to be digested ; remedies to be 
changed weekly. 

Alteratives should be selected from among those that have 
a vitalizing action on the stomach, as phytolacca, blue flag, 
stillingia, tag-alder ; tonics, as cinchona, hydrastis, collinsonia, 
gentian, nux vomica, frazerine, salicm, columbo, and mineral 
acids. 

GASTRIC CATARRH. 

A weak or relaxed condition of the mucous membrane of 
the stomach, which gives rise to an excessive secretion of mucus. 
When mucus is in excess on the stomach, the formation of the 
sarcinse ventriculi takes place, and with it is to be found the yeast 
plant in less or more abundance. Now, whether this sarcinse is 
the result of degraded living matter of the mucous membrane, 



352 DISEASES OF THE ORGANS OF DIGESTION. 

or whether it is a true vegetable germ or fungus, produced like 
the yeast plant by fermentation and atmospheric air, is not 
definitely settled. It grows like all other living matter, and 
with remarkable activity, so much so that the stomach becomes 
remarkably distended with its presence. The fungoid mass or 
jelly, tenacious in its consistency, placed under the microscope 
looks as if it was made up of blocks or square packages, living, 
growing, and imbibing nourishment from the mucus which 
surround it, and new additions by change of degradation. 

Causes. — Probably two-thirds of all cases of dyspepsia are 
of the catarrhal form, and the common causes are hurried or 
imperfect mastication. Tobacco is very productive of this 
form; hot and cold drinks; use of saccharine and starchy 
substances; late suppers; drugs, especially alkalies, such as 
bromide of potassa, alcohol, beer. 

Our semi-tropical climate, sudden changes from heat to cold 
may predispose to it. Irritation of adjacent organs, as mor- 
bid states of the liver, chronic bronchitis, phthisis, and pulmo- 
nary emphysema. In other words, any thing that will cause 
congestion of the capillary vessels of the mucous coat and 
excessive secretion of mucus. 

Symptoms. — In this form of dyspepsia there may be sore- 
ness, even rawness ; a feeling of faintness ; of emptiness ; a craving 
for food, an inability to eat, which vomiting relieves, flatu- 
lence, acid eructations, heartburn, pyrosis, weakness, coldness 
in extremities ; tongue has a white fur, may be coated, breath 
very sour smelling, disturbance of the head, heart, liver, and 
other organs. If the sarcinse become large before breaking 
down or being vomited, great distension of the stomach. 

Eructations of wind, and belching up of acid fluids, the result 
of fermentation, in which the germs of the sarcinse are found 
in great abundance, together with the yeast plant and moulds. 
The sarcinaB ventriculi can always be detected in catarrh, even 
in the mouth, but an emetic will bring up the thick, glairy, 
ropy mass, which can be seen living and growing. Its conge- 
nial abode is the stomach, where it often attains great size, 
breaks down, dies, is vomited or thrown off by the bowels in 
a sudden, unexpected attack of diarrhoea. It has been found 
in the uterus, in intro-uterine catarrh, and other hollow organs. 
If there is any doubt in the diagnosis, the microscope will decide 
the matter at once. 

Treatment. — The general principles of treatment for dys- 
pepsia must be carried out; in addition, an effort must be made 
to restore the mucous membrane to a healthy condition, and 
thus cut off nutrition and addition to the sarcinae, and employ 
means to destroy the germ. The latter proceeding is of great 
importance. 



DISEASES OF THE ORGANS OF DIGESTION. 353 

Remedies to Destroy the Germ. — The first and best remedy to 
destroy is ozone-water ; which, if taken on an empty stomach 
thrice daily, will soon penetrate the gelatinous mass. It is 
superior to all remedies, because it does not impair the gastric 
juice, nor weaken the stomach, but rather tones and strengthens. 

Probably our next best remedy is a solution of chloride of 
lime — small doses and well guarded in milk. Sulphite of lime 
is also of utility. 

The objections to those valuable antiseptics, sulphite of socla, 
chlorate and permanganate of potassa, are that in order to be 
of utility they must be administered in very large doses, so 
that they impair the pepsin and what remnant of digestive 
power may remain. 

Another plan that is sometimes very effectually carried out is : 

To Starve the Germ out. — To give emetics of lobelia twice a 
week and daily, to give scarcely any other drink but a strong 
infusion of bay berry, with small amount of capsicum, to cause 
it to be slightly stimulating. The bayberry arrests the secre- 
tion of mucus by bracing up the mucous coat. Thus between 
the action of the emetic, and the very active vitalizing agency 
of the bayberry, the sarcinse can be removed in six weeks. 

The strictest attention to diet and drinks should be observed 
for some time; the vital powers invigorated by every means 
possible. 

CATARRH OF THE STOMACH IN CHILDREN. 

Until within these few years back, the sarcinsB ventriculi 
was not met with in childhood ; now it is one of the commonest 
derangements of that period of life, among rich and poor. It 
is a constant danger to hand-fed babies, and forms one of our 
chief obstacles to the raising of infants. In older children it 
is of frequent occurrence. It seriously affects their nutrition, 
and interferes with development and growth. Mothers term it 
biliousness. The little one loses its appetite, mopes, lies about, 
has a dull, pasty or yellow complexion, and looks dark under 
the eyes. At night it sleeps badly, and is restless and irritable 
during the day. If the tongue is protruded, there is a fur on 
it, with a coat in centre ; the breath is sour-smelling ; there 
is a fullness about the stomach ; all indicating catarrh of the 
stomach, which, with its fungus, interferes with the digestion 
of the food. It may be vomited, or pass by the bowels, but it 
leaves the stomach weak, and another is likely to follow, and 
nutrition is seriously impaired. In addition to the above 
symptoms, affected children complain of pains in abdomen 
and sides, and are likely to suffer from vertigo, syncope from 
pressure upward of the distended stomach against the dia- 
phragm and heart. Bowels usually are constipated. 

35 



354 DISEASES OF THE ORGANS OF DIGESTION. 

These symptoms are greatly aggravated by an injudicious diet 
on the part of the mother, as supplying the child with an excess 
of fermentable food, as potatoes, puddings, sweet cakes, etc., 
which feed the sarcinse and keep up the dyspepsia, which is a 
source of great discomfort to the child and anxiety to the 
parent. The whole system is being fed by an acid, generated 
by the germ, and aggravated by the food, and the child is 
irritable and excessively restless His speech is hesitating; 
he may stammer ; his muscles may twitch ; his eyes wink, and 
he is nervous. 

Nausea and vomiting are not always present. If there is 
vomiting, the products are sour-smelling fluid, and thick, ropy 
mucus. Frontal headache is rarely absent ; it is often distress- 
ing; urine highly acid, loaded with uric acid. Nutrition is 
always interfered with; the child wastes perceptibly, or there 
are fainting fits. 

In curing gastric catarrh in children, the sarcinae must be 
either removed, destroyed, or starved out. The acrid mucus 
and germ is the constant cause of acidity and fermentation ; 
they keep up a bad train of symptoms. The greatest benefit, 
therefore, is to be derived from the action of an emetic dose of 
ipecacuanha wine, and afterward bayberry in the form of 
a compound elixir. Open bowels with compound liquorice 
powder. If there is fever, aconite. Then follow in with ozone- 
water to destroy the germ. Diet carefully guarded ; no starchy 
or saccharine agent given ; nothing to aid fermentation ; toast, 
milk, and lime-water. As soon as tongue cleans, appetite returns ; 
boiled fish, white of chicken, lean broiled mutton. It is not well 
to press the child to eat ; rather refrain. To give tone to the 
stomach and strengthen digestive powers, sulphate of cinchona 
or wine bitters. 

In order to prevent gastric catarrh becoming a prevailing 
disease among children, mothers must learn that all sugar and 
starch articles of diet are poisonous to children. They should 
also be made aware of the great utility of a flannel binder or 
roller next the skin as an indispensable article of a child's dress 
till it reaches three years of age. This roller should reach from 
the armpit to the groin ; not pinned too tightly. The resist- 
ing power of all children should be fortified by gradually 
bringing their morning and evening bath to cold water. It 
must be a very gradual process in weak children ; in all cases 
followed by active rubbing. To bring children to the cold 
bath and practice it properly, has a most tonic effect upon the 
system generally, and confers great resisting power upon the 
part of the child, and reduces its susceptibility to any change. 
Mothers should also he instructed of the utility of brisk mas- 
sage over body after child has been dried off. 



DISEASES OF THE ORGANS OF DIGESTION. 355 

DISEASES OF THE DUODENUM. 

There has been an effort made to map out the diseases of the 
first twelve inches of the small intestine, chiefly on account of 
its anatomical character, its intimate relation to the pancreas 
and liver, the very fine texture of its nerves, and its remarka- 
ble action, or rather source of attraction for such poisons as 
bismuth, lead, etc.; but the diagnosis is always difficult, even 
obscure from other intestinal affections. 

Inflammation of Duodenum. — Acute inflammation is sel- 
dom limited to the duodenum; generally associated w T ith some 
disease of the stomach, as acute or chronic gastritis, or with 
the same condition in the small intestine ; or with inflamma- 
tion of the gall-bladder, or under surface of the liver. 

Symptoms. — The localized pain over the regioD of the duo- 
denum, aggravated by pressure, movement. The tenderness 
is quite great ; the very fine, delicate character of the nerves 
renders it so. Thirst ; appetite unaltered or impaired ; nausea 
and vomiting ; diarrhoea, with unnatural and offensive stools ; 
very great weakness, mental anxiety, and loss of flesh. When 
complicated with inflammation of biliary apparatus or impacted 
gall-stones, there will be jaundice. If there be any pancreatic 
disease, there will be fat or oil globules in stools; tongue gene- 
rally coated brown, with transverse fissures; two or three hours 
after taking food, the pain and distress greatest. 

Treatment. — Irritating plaster over tenderness, compound 
licorice powder to open bowels ; rest, mild diet, mucilaginous 
drinks of slippery elm, opium to relieve pain, alteratives and 
tonics. Special remedies for inflammation, or disease of liver 
and pancreas. 

Duodenal or Intestinal Dyspepsia may result from the 
same causes as indigestion in stomach. 

Symptoms. — All or some of the symptoms of indigestion 
of the stomach only coming on tw T o or three hours after meals ; 
tongue coated white and brown, with transverse fissures; nau- 
sea, attacks of faintness; very often more or less jaundice. 

Treatment for Dyspepsia, remedies being chiefly those that 
act on liver, as phosphate of soda, nitro-muriatic acid, and 
compound tincture cinchona ; sulphate quinine and aromatic 
sulphuric acid; ammonia acetate, ph}'tolacca, leptandra. 

Perforating Ulcer of Duodenum in its symptoms resem- 
bles gastric ulcer, added to which there may be more persistent 
nausea and vomiting, with diarrhoea and bloody stools; great 
prostration. In extensive burns, sloughing ulcers of duodenum 
are very common, owing to the internal congestion. 

Cancer of the Duodenum is recognized by its cachexia, 
the location of pain, it being both in back and front; indiges- 



356 DISEASES OF THE ORGANS OF DIGESTION. 

tion, biliary symptoms, tongue coated brown, with transverse 
fissures. 

General treatment for cancer ; absolute relief of pain ; apply 
ozonized clay early and persistently, it often silently works 
wonders. 

ENTERITIS. 

Inflammation of the small intestine varies much in severity. 
It may be very slight, or of a very high grade. It is usually 
impossible to localize it in any particular part of the bowel. 
Irritation, either internal or external, a common cause. 

Symptoms begin with pain around the. umbilicus, aggra- 
vated by pressure ; nausea, vomiting, rigors, and a fever ; great 
headache, features pinched, tongue buff-leather coated, heat 
high, pulse wiry; great restlessness, prostration, anxiety of 
countenance. If the mucous coat alone is involved, there will 
be a muco-enteritis, or acute intestinal catarrh, and diarrhoea, 
with mucous, bilious, or serous stools. When the peritoneal 
and muscular coat is involved, there is obstinate constipation. 
The patient assumes the position on back, with knees drawn 
up so as to relax the abdominal muscles ; often delirium ; 
vomiting becomes more persistent, and vomited matter highly 
offensive, sometimes stercocareous. 

Treatment. — Perfect rest in bed ; either a large fly blister 
for six hours, or turpentine, until a good degree of redness is 
induced, followed by hot flaxseed-meal poultices with opium, 
changed pretty frequently at first. Empty rectum with ene- 
mata of warm water and laudanum. Sponge surface thrice 
daily; heat to feet. Case bad, skin pungent, hot : jaborandi, 
opium pulverized with tincture of the green root of gelseminum, 
in doses often but small, from half to one grain of opium every 
hour, with from ten to twenty drops of the gelseminum. If 
jaborandi is administered, there must be no drink ; if not given, 
then mucilaginous drinks, beef-tea, milk, and lime-water. The 
principal drugs are the opium and gelseminum, during the 
active as well as during the convalescing stage ; any disposition 
to collapse, ammonia and quinine. During convalescence, apply 
a flannel roller over abdomen. Simple animal food, milk, raw 
eggs, and such remedies as an infusion of bayberry, aromatic 
sulphuric acid and quinine, golden seal. 

Catarrhal Enteritis. — This is a very common affection, gene- 
rally classed as a diarrhoea, although it is a true inflammation of 
the mucous coats of the intestines. As a rule, intestinal catarrh 
has a very limited area of distribution in most cases. It can 
usually be localized by the soreness, and if near the duodenum, 
by some jaundice; if near the rectum, by the tenesmus or bear- 
ing down, while the pain or soreness enables us to locate it in 



DISEASES OF THE ORGANS OF DIGESTION. 357 

some particular spot. The significance of the stool is of great 
value — mucus. Pure mucus indicates a disease of the sigmoid 
flexure ; scybala or hardened lumps of feces in mucus, an affec- 
tion of the colon. The stools may be large and covered with 
mucus, and no pain ; or the stools may be soft, and incorpo- 
rated with mucus of a pulpy, thick consistence, or full of mucus. 
If there be unaltered food in the stools, fat or starch, the pan- 
creas is at fault. 

Treatment. — Milk diet, with lime-water ; rest ; mustard over 
soreness; flannel roller over abdomen. Try first compound 
tincture cinchona and aromatic sulphuric acid, three times a 
day ; drink freely of a tea of bayberry. If that is not success- 
ful in a few days, try the white mustard seeds ; that failing, 
which is scarcely possible, try aromatic sulphuric acid, fifteen 
drops every three hours in water. 

INFLAMMATION OF THE CiECUM. 

The csecum or its appendix, situated in the right iliac fossa, 
and covered by peritoneum only anteriorly and latterly, may 
be seriously diseased, without any other part of the intes- 
tines being affected. Thus severe colic, and even fatal ileitis, 
may arise from the lodgment in this part of the canal of 
hard, fecal matter, skins or stones of fruit, orange seeds, gall- 
stones, fish bones, foreign bodies, balls of intestinal worms. 
Sometimes fecal matters accumulate to such an extent as to 
form a very large mass, and many cases of recovery might be 
cited which took place upon the passage of a large quanity of 
feces, when the fecal enlargement had been pronounced a tumor 
by an ignorant practitioner. When any morbid matters get 
impacted in the vermiform appendix of the csecum, they are 
very apt to give rise to inflammation, ending in abscess. 

Symptoms. — In the acute form, there is fever, nausea, con- 
stipation; fulness and tenderness about right iliac region; pain 
rendered exquisite by pressure. Position on right side selected, 
with trunk somewhat bent, and knees drawn up to relax abdo- 
minal muscles so as not to press on painful tissues. If peri- 
toneal coat becomes involved, may have general peritonitis; 
or areolar tissue around caecum may become inflamed, and 
result in suppuration and abscess; when this takes place, it is 
called perityphilitis. 

When inflammatory action begins in the vermiform appendix 
from constitutional causes, or escape into this part of morbid 
matter, symptoms are very acute, excruciating, griping ; tym- 
panites ; hiccough ; violent sickness ; obstruction of the bowels ; 
great pain, extending to right ovary or testicle, and shooting 
down the inside of the thigh. Gangrene and general perito- 
nitis may follow, and cause death ; or a portion of large intes- 



358 DISEASES OF THE ORGANS OF DIGESTION. 

tine and caecum, with appendix, may slough off, be passed with 
stool, and recovery is possible. In tubercular typhilitis, ulcera- 
tion is very apt to occur. 

In chronic caecitis, symptoms come on very slowly, and there 
is fever, failing health, weakness, loss of flesh, colicky pains in 
right iliac fossa, flatulence, loss of appetite, constipation alter- 
nating with diarrhoea. If there is ulceration of mucous coat, 
diarrhoea, haemorrhage, exhaustion. 

When perityphilitis takes place, that is, inflammation of the 
areolar tissue connecting the caecum with the psoas and iliac 
muscles, there are severe shooting pains down the right iliac 
region ; constipation or diarrhoea, with tenesmus, nausea, men- 
tal depression, pain and tenderness over caecum, with tumefac- 
tion and increased resistance to pressure, and perhaps fever. 

Treatment must be carried on on general principles. If 
there is fever, aconite and gelseminum. Opium is our chief 
remedy; not as an anodyne, but on account of its peculiar 
action on the bowels. The crude drug in pulverized form, with 
two or three grains of ipecac, every three hours. It has a magi- 
cal effect upon the caecum and appendix, and must be given in 
all cases. Olive oil enemata morning and night; mucilaginous 
drinks ; hot linseed poultices ; perfect rest in bed ; milk and 
beef-tea diet. If symptoms of suppuration set in, quinine and 
stimulants. 

DIARRHOEA. 

In health, the ingesta of the intestines completes its revolu- 
tions once in twenty-four hours. In that period the process of 
digestion is completed, the carrying forward of the contents of 
the food digested in the stomach converted into chyme and 
chyle, and its expulsion, after seven or eight hours of refreshing 
sleep, as feces should be accomplished ; and this, to be in perfect 
accordance with healthy laws, should take place after the peris- 
tallic wave has been excited by the mastication of the morning 
meal. Any deviation from that rule is disease. 

Diarrhoea is a condition in which there are more frequent 
evacuations of the bowels without pain ; properly speaking, a 
weak or relaxed condition of the mucus, serous, or muscular 
coats, which gives rise to liquid stools. 

Causes. — Climatic changes, fruits, drugs, acidity, improper 
food, excess of bile, nervous shocks, disease-germs, ulceration 
of bowels. 

Symptoms. — Purging, nausea, tongue coated, foul breath, 
flatulence, and griping; acid eructations; some bearing down; 
stools are either watery or mostly mucous, or contain an excess 
of bile or indigested food, or mucus and blood. 

This brings about a division into serous, mucous, biliary, 



DISEASES OF THE ORGANS OF DIGESTION. 359 

feculent, etc. A point of importance in the treatment of each. 

Feculent Diarrhoea. — The most common form of diarrhoea 
among over-indulged and over-fed children, or among adults 
who eat indiscreetly. 

The characteristics of this form of diarrhoea are, looseness 
of the bowels, with or without griping pain; discharge of par- 
tially digested food, with serous and mucous exudation, sour- 
smelling, frothy, and fetid, of different odors and colors. This 
condition is accompanied by partial or complete loss of appe- 
tite, pain in the stomach, swelling and tension in the lower 
part of the abdomen; cold, dry skin; thirst, nausea, straining; 
urine scant} 7 ; weakness and fainting. 

Causes of this form of diarrhoea are heat, confinement, den- 
tition, worms, irritating and indigestible food, as mince-pie, 
pastry, nuts. 

In the treatment of all forms of diarrhoea, there should be 
worn a flannel roller around the abdomen, and rest in the 
recumbent posture, and very little food or drink for ten or 
twelve hours. 

If it occur during the period of dentition, look to the gums, 
and, if teeth are penetrating through, scarify. Small doses of 
the neutralizing mixture should be given repeatedly, followed 
by compound syrup bayberry. 

If caused by indigestible food, an emetic of the wine of 
ipecac, in doses according to the age of the child ; follow with 
compound licorice powder, so as to cleanse out the bowels. 
If tongue is still coated, give aromatic sulphuric acid and 
quinine ; if tongue is clear, give an infusion of bayberry and 
poplar bark. Use no astringents. The diet should be confined 
chiefly to milk, beef-tea. 

Serous Diarrhoea. — In this form there is a relaxation of the 
capillaries, usually of both serous, and mucous coat. Their 
vitality is much impaired, and exudation of serum takes place 
in great abundance. The roller, and rest. If tongue is coated, 
avoid astringent remedies ; give solid food, and use mineral 
acids, as aromatic sulphuric acid, and quinine, compound tinc- 
ture cinchona. If the tongue is clean, astringents can be given 
with propriety, as a drink of boiled milk, with cinnamon sticks 
and lime-water, infusion of crane's-bill, tincture of catechu. 

Biliary Diarrhoea. — Usually some derangement of the liver, 
either from heat, malaria, whisky, or carbonaceous food, or from 
congestion by cold or mental emotion, or some other condition 
that causes the bile to be poured out in excessive quantity. 

It is easily recognized by the brown-coated tongue and gin- 
ger-bread appearance of the stools, thin and brown. 

In the treatment, rest, hot fomentation over liver ; if there is 
nausea, an emetic ; cleanse out bowels with compound licorice 



360 DISEASES OF THE ORGANS OF DIGESTION. 

powder; then follow with compound tincture cinchona and 
nitro-muriatic acid, or hydrastine, quinine, and nux vomica, 
and a milk diet. 

Muco-Purulent Diarrhoea is best treated with infusion of 
bay berry and poplar. If that fail, and mucus or pus is persis- 
tent, try turpentine in acacia or carbolic acid and tincture of 
iodine ; if tongue is clean, opium and tannin in pill form. 

Chronic Diarrhoea. — This form of diarrhoea is said to exist 
when either of the others last for a long time. There is very 
apt to exist some ulceration of either the mucous or serous 
coats. In chronic diarrhoea w r e have also to contend with a 
perfect loss of tone in the bowel, an inability to digest or hold 
its contents. In this form the diet should be solid, highly 
nutritious, the roller should be worn, and rest inculcated ; no 
fruit ; an alterative and tonic course invariably ; movements 
of bowels restricted to one per day by the opium and tannin 
pill, or by the tincture of kino and chalk mixture ; a strong 
infusion of bayberry should be made every morning, with 
some poplar bark or a little capsicum ; this the patient should 
drink during the day; no drug in the materia medica like 
bayberry for invigorating the different coats of the bowel. Its 
continued use does not impair its efficacy. 

Dirarrhoea in Typhoid. — As a general rule, the antiseptics 
take care of it, especially the carbolic acid and iodine mixture ; 
but if it is troublesome and not controlled, it is to be regarded 
as a distressing and dangerous symptom. It must be arrested; 
never encouraged on the fallacious idea that the germs escape 
b}^ the stools. True, the retention of the germs is bad, but 
diarrhoea is weakening and dangerous, as it tends to rupture 
of the thin-based ulcers on the bow T els. Opium and tannin 
should be given sufficiently often to control. 

Melaena or Black Stools. — Diarrhoea, with stools like tar, 
is due to the presence of blood from the stomach or bowels 
acted on by the intestinal juices. Degeneration of the liver 
necessarily gives rise to congestion of the gastric and intestinal 
vessels, a condition that gives rise to extravasation of blood 
from the gastro-intestinal membrane. It may be present in 
enteritis and other morbid conditions of the alimentary canal. 

CONSTIPATION. 

Constipation may be confined to a condition in which there 
does not take place the usual act of defecation once in the 
twenty-four hours, but it is delayed for some days. It is to 
be regarded as a condition of gastro-intestinal torpor, but no 
structural disease. The natural peristaltic action of the bowels 
is changed and deranged from some cause. It may be due to 
carelessness and non-attention to natural laws, want of exer- 



DISEASES OF THE ORGANS OF DIGESTION. 361 

cise, improper food, a deficiency of bile, want of nervous ener- 
gous, or impaired vital force, such as exists in tuberculse, 
ansemia, chlorosis, debility. 

Symptoms. — An arrest of the peristaltic wave from what- 
ever cause impairs the function of the stomach, liver, and 
pancreas. It gives rise to mental and physical depression or 
oppression; a sallow and pasty complexion; foul breath, dry 
skin, scanty urine; no stools, or only a scanty, pale-colored one, 
very offensive every few days ; a loss of all power for exertion, 
distressing headache, aggravated palpitation, severe neuralgia, 
and confirmed hypochrondriasis. 

Treatment. — The cure of constipation by purgatives is not 
in accordance with the principles of either common sense or 
true science. To cure, we must know the cause upon which 
it depends, and cure by the removal of cause, and by impart- 
ing tone, vigor, by bathing, proper food, exercise, stimulating 
the biliary secretion, arousing nervous energy, and improving 
the secretory and peristalitc powers of the intestines. 

We commence, then, with the diet, and inculcate abundance 
of wholesome, digestible food, with vegetables, ripe fruits, and, 
when out of season, figs, prunes; oatmeal porridge, brown 
bread; tumblerful of water before retiring to bed. Sedentary 
habits are to be avoided; moderate exercise; bathing daily — 
ordinary bath followed with shower. Immediately after the 
morning meal, an enemata of cold water, to be retained as long 
as possible, thus soliciting the bowels to respond at a regular 
hour daily. With this simple management, inculcate a law of 
habit, which has a beneficial effect in constipation — a habit of 
defecation at a particular time daily, and, to conform to physio- 
logical law, after the morning meal. The act of mastication, 
slow and thorough, starts the peristaltic wave, and propagates 
its impulse to the entire thirty -two feet of bowel. Water is a 
good remedy in constipation ; when the stomach is empty of 
food, a glass or more should be taken. Its use is often attended 
with marked benefit. 

In constipation irrespective of cause, or what is termed 
habitual, one teaspoonful of cascara sagrada, fluid extract, at 
bed-time, will at once relieve it; continue for a few weeks till 
law of habit is established. Gentian, collinsonia, golden seal, 
from among bitter tonics, are quite efficacious. Ox-gall, dried 
to the consistency of soft putty, in doses of from five to ten 
grains daily, alone or combined with extract of mix vomica, 
is also useful. If the constipation be due to want of nervous 
energy, nux vomica is the best remedy ; the tincture in from 
eight to fifteen drop doses in water, thrice daily. If due to a 
deficiency of bile, then such remedies as leptandra and nux 
sulphur, or compound licorice powder, nitro-muriatic acid in 



362 DISEASES OF THE ORGANS OF DIGESTION. 

compound tincture of cinchona, dandelion, and other remedies 
to rouse up the action of the liver. The practice of kneading 
bowels, electricity, etc., is not to be commended. 

OBSTRUCTION OF THE BOWELS. 

Intestinal obstruction is a fearful disorder, which may arise 
from a large variety of causes. The most common of all causes 
are those that arise from strangulated hernia, and, in all cases 
of obstinate constipation, it is well to be on the lookout for 
hernial protrusion or twisting. 

Intestinal obstruction is usually divided into three classes, viz. : 

(1.) Intermural, or those originating in and implicating the 
mucous and muscular coats of the intestinal walls. 

(a.) Cancerous stricture. 

(b.) Non-cancerous stricture, comprising : 

1. Contractions of walls of intestine from inflammation, 
deposit of lymph, or structural injury. 

2. Contraction of cicatrices, following inflammation and 
ulceration. 

(c.) Intussusception. 

(d.) Intussusception associated with polypi. 

(2.) Extramural, or those causes acting from without, or 
affecting the serous covering. 

(a.) Bands and adhesions from effusion of lymph. 

(b.) Twists or displacements. 

(c.) Diverticula. 

(d.) External tumors or abscesses. 

(e.) Mesenteric hernia. 

(/.) Diaphragmatic hernia. 

(g.) Omental hernia. 

(h.) Obturator hernia. 

(3.) Intramural, or obstruction produced by the lodgment 
of foreign bodies. 

(a.) Hardened feces, concretions having for their nuclei gall 
stones. 

Of these different forms, the most common and the most 
important is intussusception, which occurs most commonly 
among women and children, the symptoms being sudden col- 
lapse, and seizure of abdominal pain, rigors, nausea, vomiting, 
not always constipation, passage of bile and blood. In spare 
ladies, a tumor can be felt at the seat of invagination. 

Causes. — Blows, falls, strains, lifts, bearing down, coughing, 
jumping, running, injuries which may give rise to displacement 
and inflammation. 

Symptoms. — Nausea, vomiting, first of mucus and contents 
of stomach, but, in a few days, fecal matter. Pain very severe, 
tympanitis, hiccough, mental depression, usually constipation ; 



DISEASES OF THE ORGANS OF DIGESTION. 363 

increased fulness and tenderness can often be detected over 
the obstruction ; early prostration ; either acute peritonitis, or 
tetanus, from reflected irritation, liable to set in. Patient may 
die of either. 

Intussusception is a condition of the bowel in which one 
part of the bowel is drawn into another, just as the finger of 
a glove is pulled within itself. Owing to the congestion and 
effusion that result from the irritation, the canal of the bowel 
is more or less obstructed. The intussusception may be single, 
or there may be half a dozen or more. Common in both sexes 
in all ages; of very frequent occurrence, after labor, in large, 
flabby women. 

Symptoms. — Collapse; sudden, violent pain, sickness, vom- 
iting, rigors, biliary diarrhoea; other cases, constipation. If 
spontaneous reduction does not take place, one of two things 
will happen: either reflex irritation and tetanus in those whose 
nervous system is depressed, or inflammatory symptoms, peri- 
tonitis, with inflammation of the coats of the bowel, which 
may terminate in gangrene; in either form apt to prove fatal. 

Treatment. — When in doubt, castor oil and opium are our 
remedies. If satisfied that a mechanical obstruction exists, 
rely on opium, or opium in alternation with belladonna — a 
grain of opium every three hours. It has a most excellent 
effect on the coats of the bowel. Crude opium has a better 
action than morphia. Add ipecac if belladonna does not oper- 
ate favorably. Hyosciamus, two grains to one of opium, repeated 
every two or three hours, operates well, as the hyosciamus has 
a special action on the walls of the bowels ; affords relief in 
the most desperate cases; hot bath ; enemata of large quantities 
of fluid, with gentle manipulation of intestines by pressure on 
them through the abdominal walls; inflation by air while 
under chloroform. 

Intestinal Concretions. — Calculous concretions are rare in 
the intestines of human subjects, compared with animals. In 
man they are more common in caecum and colon than in other 
portions of the alimentary canal. A gall-stone or foreign body 
may attract around it imperfectly crystallized earthy salts and 
indigestible fibrous matter in concentric layers. Other concre- 
tions may consist of hardened faeces, with the phosphate of lime 
and magnesia, or of chalk or carbonate of lime, where these 
substances have been largely taken ; or of hair, cotton, paper, 
where a depraved appetite has led to their being swollen ; or of 
gall-stones with layers of inspissated mucus and fecal matter. 
Either kind may increase in size until there is a perfect obstruc- 
tion of the gut. In fortunate cases, concretions have been 
expelled by vomiting or by stool. If situated in the rectum, 
they may be scooped out. 



364 DISEASES OF THE ORGANS OF DIGESTION. 

Intestinal Perforation. — The intestine may be perforated : 

1. By incised or other wounds. 

2. By disease in the coats of the bowels, as the ulceration 
of typhoid fever, inflammation of csecum, dysentery, ulcer, 
cancer, etc. 

3. From extension of ulceration in disease of adjacent organs, 
as in abscess of liver, culculi in gall-bladder, ovarian tumors, 
extra-uterine pregnancy, ovarian abscess, cancer of uterus and 
vagina, suppuration in abdominal parietes. 

FLATULENCE. 

An accumulation of gas in the intestines may take place 
from various causes, as the product of fermentation and imper- 
fectly digested food. The flatus is most abundant a few hours 
after food ; no derangement of the general health ; often pro- 
duced by green vegetables, as peas, beans, or any food that 
quickly undergoes decomposition or fermentation. 

It may also be due to the air swallowed in supping food, 
or to disorder of the gastric and intestinal mucous secretions, 
as in dyspepsia, atony, and weakness of the bowels. 

Besides being an accompaniment of indigestion, disorders, of 
stomach and bowels, intestinal obstruction, organic disease of 
the liver, peritonitis, typhoid fever, uterine irritation, etc., it 
may also depend on nervous causes. In all cases the removal 
of the cause, the avoidance of a diet liable to ferment, as peas, 
beans, etc, and the use of compound tincture cinchona, and 
nitro-muriatic acid, gentian, ammonia and chloroform — drugs 
that tend to brace up the bowels. 

COLIC. 

This is characterized by severe griping or twisting pain in 
belly, especially about the umbilicus, occurring in paroxysms. 
Pain generally relieved by pressure ; never aggravated by it ; 
there is often vomiting, and generally constipation ; an entire 
abscence of fever and inflammation. During an attack pulse is 
lowered ; surface of the body cold ; face white and anxious. 
There are numerous varieties, as flatulent, bilious, nervous, 
brass, lead, and other minerals. 

Flatulent Colic. — Generally due to excess or indigestion, 
accompanied by wind ; relieved by eructation, or explosion of 
gas, or by vomiting or purging. Best relieved by the admin- 
istration of a gentle emetic of a teaspoonful of common salt, 
and half a teaspoonful of mustard in half a tumbler of water, 
or lobelia, followed by tonics and aromatics. 

Bilious Colic. — The irritation of acid or acrid bile, or other 
morbid secretions, often irritates the nerves of the bowels, and 
causes contraction of the muscular coats. 



DISEASES OF THE ORGANS OF DIGESTION. 365 

In those cases there are usually the dullness, the brown coat 
on tongue, the yellow tinge on the white of the eye, fcetor of 
breath, etc. 

This is best relieved by the admistration of small doses of 
the anti-spasmodic tincture, or a warm infusion of the wild 
yam or dioscoria, followed up with the compound licorice 
powder, or neutralizing mixture, with leptandra, oil of pepper- 
mint and anise, or with more active remedies to stimulate the 
liver, as phosphate of soda or nitro-muriatic acid. 

Nervous Colic comes on from fright, cold, hysteria, gout, 
rheumatism, or from irritation of adjacent organs, as the blad- 
der, uterus, or morbid conditions of the alimentary canal. 

This must be promptly relieved by the administration of 
chloroform in sweetened water internally, or belladonna, or 
anti-spasmodic tincture, phosphate of quinine, colchicum, and 
the cause removed. 

Tin Colic. — This form of mineral colic has become very 
common since the introduction of canned vegetables, fruit, 
beef, fish, and also caused by cooking soup in tin culinary ves- 
sels on petroleum cook stoves. 

Relieve the pain and spasm by the usual means, and put 
patient on iodide of potassa and carbonate of ammonia. 

Copper Colic. — A most severe form of twisting or griping ; 
comes on suddenly; pain is intense; nausea, vomiting ; bowels 
generally loose. The countenance is anxious, of a peculiar, 
sallow hue ; eyes sunken and lips livid ; a purple line around 
gums. Common among copper-plate printers, brass founders, 
and from copper cooking vessels. Treatment same as lead colic. 
Bismuth Colic. — Bismuth introduced into the stomach 
blunts the sensibility of the gastric nerves, but when exten- 
sively used, as it often is by ladies in face powders and cos- 
metics, gives rise to colic, w T ith a peculiar bluish, shrivelled, or 
wrinkled appearance of the skin, and after death, the duode- 
num is black with the debris of the metal. Same treatment 
as lead colic. 

Lead Colic. — Due to the absorption of lead; hence, it is 
common among operatives in lead works, oil-cloth factories, 
painters, plumbers ; drinking from lead pipes, soda water from 
lead taps, snuff adulterated with lead, claret drinkers, as sugar 
of lead is often added to wines to render them cooling ; and 
wine casks absorb the lead, and if ever used for carrying water 
in ship, they re-impregnate the water, and the sailors, or those 
drinking the water, become affected. Lead, whether inhaled 
by the skin or bronchial mucous membrane, or absorbed by the 
glands of the mouth, or swollowed in water or food, or breathed 
from a newly painted room, diffuses itself through the body, 
but seems to spend the force of its poisonous effects on the fine, 



366 DISEASES OF THE ORGANS OF DIGESTION. 

delicate nerves of the duodenum, giving rise to an irritation 
which speedily terminates in a spasm or contraction of the 
muscular coat of the bowel, so that it is usually ushered in by 
a grinding or twisting near the umbilicus, with retraction of 
the abdominal muscles to the spine, aud pain in the back, 
vomiting, constipation, metallic aspect of countenance, a blue 
or slate-gray line round edges of the gums, with general lan- 
guor and debility. 

Treatment. — To prevent absorption of this metal, workmen 
employed in or about it should exercise great care resorting 
to daily baths, wear flannel clothing, keep bowels regular, eat 
the most nutritious diet, and spend a good portion of time in 
open air. 

Aromatic sulphuric acid, fifteen drops thrice daily in water, 
prevents absorption, and is undoubtedly the best prophylactic. 
Alum is not a preventive, but, if given after the lead is in the 
fluids and solids of the body, it will unite with the metal and 
form an innocent sulphate. Although alum has this remark- 
able chemical property of cha aging the lead, it does not pre- 
vent its ingress into the body, like the aromatic sulphuric acid. 

In suffering from an attack, the first thing to be done is to 
relax the spasm, and relieve the patient from pain. The com- 
pound lobelia, with capsicum and valerian, should be admin- 
istered by mouth and rectum in small doses, often repeated, 
so as not to excite emesis ; and if the spasm does not yield, 
administer thirty drops of chloroform with it for several times. 
Relieve pain by hypodermic injection of morphia. 

As soon as the spasm is relaxed, and a free motion of the 
bowels brought about by oil, begin with iodide of potassa. 
This drug unites with the lead, sets it free, and also eliminates 
it by the skin, kidneys, and bowels. The dose of the iodide 
should not be less than five grains, three times daily ; but it 
is often beneficial to give it in ten-grain doses, and combine it 
with either bicarbonate of potassa or carbonate of ammonia ; 
the whole to be given in syrup of stillingia compound. While 
pursuing this treatment with iodide, an every-day bath of the 
sulphuret of potassium. This should be done in a wooden 
bath-tub, with tepid water enough to cover the body, to which 
one pound of carbonate of soda and sulphuret of potassium 
should be added. The patient should remain in bath not less 
than half an hour, even a little longer. 

The diet should, while pursuing this treatment, be generous 
to a fault. 

ENTOZOA. 

The parasitic animals which infest the human body are 
very numerous, and are in all respects different from disease- 



DISEASES OF THE ORGANS OF DIGESTION. 367 

germs. A parasite is an organism that lives upon another 
organism. The organism does not evolve the parasite. The 
parasite is the descendant of a pre-existing parasite; not an 
evolution or emanation upon and by which it lives. The 
living, growing cells of the human body are not parasites, nor 
no amount of degradation can make them parasites. Every 
cell in the human body has been formed by direct descent 
from the original embryonic mass of bioplasm. The living 
matter of each cell is capable of growth and multiplication, 
but it cannot be looked upon as a parasite upon other cells ; 
for its parentage is the same as theirs. Even degraded cells, 
such as tubercle, cancer, should not be regarded as parasites 
living upon healthy cells, although many forms of altered 
bioplasm can be transferred from animals to man, and grpw 
and multiply. All such have been derived from normal cells, 
which would grow and multiply if transferred from one organ- 
ism to another. As living matter retrogrades, it acquires the 
power of living upon much less elaborate pabulum than the 
normal bioplasm, and it may even appropriate different kinds 
of pabulum. Its rate of growth and multiplication is far 
greater than that of normal bioplasm from which it came, and 
it retains its vitality under circumstances which would have 
entirely ensured the destruction of the latter. A parasite is 
as much a species as the living being upon which it feeds ; a 
parasite possesses individuality and characteristics which it 
can transmit for countless ages. 

(1.) Fasciola Hepatica. — Liver fluke. This has been found in 
the human gall bladder and faeces. . It is quite small — less 
than half an inch long, and a quarter of an inch broad; quite 
flat, covered with minute spines of an oval form, and capable 
of contraction, like a leech; has an oral and ventral sucker, 
the orifice of the male and female organs being placed side by 
side, near the ventral sucker. Bile is its nourishment. There 
are four other varieties of the fluke family, mostly found in 
the bile and intestines ; some of them so very small that they 
seem capable of passing out of the intestines, and have been 
found in the eye. 

(2.) Distoma Haematobium. — A cylindrical trematode worm, 
nearly an inch in length ; males and females distinct; former 
the largest, and having on under surface of abdomen a longi- 
tudinal groove, in which the female is lodged during copula- 
tion. It inhabits the vena portse, and the veins of the mesen- 
tery, liver, bladder, kidneys. It is very common in our Southern 
intermittent, especially along the banks of the Mississippi, and 
gives rise to hsematuria. 

(3.) Tetrastoma Renale. — Has a small oval, flattened bodv, 



368 DISEASES OF THE ORGANS OF DIGESTION. 

about five lines long, and provided with four suckers, is found 
in the uriniferous tubes of the kidneys. 

(4.) Hexathyridium Pinguicola. — A flat trematode, about eight 
lines in length, often found in ovarian tumors. 

(5.) Hexathyridium Venarum. — About three lines in length, 
found in the sputa of those affected with chronic bronchitis. 

(6.) There are five different forms of tape worms found in 
the human body, out of the two hundred and fifty said to 
exist. 

(a.) Taenia Solium. — This is a large cestode helminth, which, 
when mature, may measure thirty-two feet, and in breadth, 
half an inch. Its head is very small and flattened, and provided 
with a projecting papilla, armed with a circular row of hooks 
and four suckers; the neck long and narrow. The cysticus 
cellulosse, or pork measles, is the larva of this tape worm. See 
Intestinal Worms. 

(b.) Tsenia Mediocancellata. — A cestode worm, attaining a great 
length, and having larger segments than the solium. Head 
is furnished with large sucking-discs, but destitue of a ros- 
tellum and hook apparatus. The cysticerci or measles that 
produce this worm are to be found in the muscles of cattle. 
This hookless worm is quite common. 

(c.) Tsenia Marginata is very rarely found in man, but common 
in the dog. 

(d.) Taenia Echinococcus. — A very small cestode helminth, 
infesting the dog and wolf. In man it is met with in the 
female breast, testis, brain, spleen, liver, heart, lungs, and in 
bones. 

(e.) Bothriocephalus Lotus. — A very large cestode helminth, 
measuring over thirty feet, and over an inch wide, and is the 
largest ever met with in the human body. Each joint or 
segment possesses its ovary and sexual apparatus. 

(7.) Ascaris Lumbricoides. — In size and appearance like the 
ordinary earth worm, only white instead of red. Males, about 
six inches long ; females measure twice as long. 

(8.) Ascaris Mystax. — A nematode worm characterized by the 
presence of aliform appendages, one being placed at each side 
of the head. Males, two and a half inches long; females, 
double that length. Common in cats, and also found in human 
body. 

(9.) Ascaris Trichinae. — A long thread-like worm found in 
the rectum, colon, and caecum. Males measure three-quarters 
of an inch ; females, two inches in length. 

(10.) Trichinae Spiralis. — See Trichinae. 

(11.) Filaria Sanguinis Hominis. — A microscopic worm found 
in the blood of those suffering from chyluria. See Filaria. 



DISEASES OF THE ORGANS OF DIGESTION. 369 

(12.) Filaria Bronchialis. — Commonly met with in bronchial 
and lympthatic glands in chronic bronchitis. Measures from a 
quarter of an inch to one inch. 

(13.) Strongylus Gigas. — Not uncommon in the human kid- 
neys. 

(14.) Sclerostomy Duodenale. — A small worm about an inch 
in length. It seems to be associated with anaemia. 

(15.) Oxyuris Vermicular is. — The smallest of the intesninal 
worms peculiar to man, occupying the rectum. 

(16.) Dracunculus Medinensis, or Grecian worm. See Dracontiasis. 

(17.) Pentastoma Tsenoides. — It is found in the wolf and dog, 
and its larva has been found in bronchial tubes and bowels of 
man, but it does not grow. 

(18.) Pentastoma Constrictum has been found in the liver of 
the negro and Mongolian. 

(19.) Pseudelmenths. — A large number of worms have been 
introduced into human excrement for the purpose of deception. 

INTESTINAL WORMS. 

The number of animal parasites that inhabit the alimentary 
canal are variously described as between thirty and thirty-five, 
but this enumeration only tends to gratify a morbid curiosity ; 
for, practically speaking, they can be included under three dis- 
tinct heads, so as to embrace symptoms and cure. 

Predisposing Cause of Worms Generally. — In health, no dis- 
ease-germ, parasite or fungus, can breed or grow in or on the 
human body, but if depressed or weakened, or devitalized, 
there is then a field for them to grow, if the larva or seed is 
introduced. 

Exciting Cause. — The spontaneous germination of parasites 
is opposed to all scientific truth. In all cases, the larva or eggs 
must find their way in by the skin, breath, drink or food. 

General Symptoms. — These are somewhat variable when 
worms exist ; still, the following are nearly always met with : 
capricious appetite, acid eructations, pains in the stomach, grind- 
ing or grating of teeth during sleep; fetid breath, coated tongue, 
picking at the nose, white or pasty appearance of the counte- 
nance, dark ring about eyes and mouth, hardness of abdomen, 
griping pains about umbilicus, itching at rectum and funda- 
ment, irregularity of bowels ; an indescribable feeling of debility, 
often heats and colds; short, dry, hacking cough; general 
emaciation; often febrile paroxysms; irregular pulse. Reflex 
symptoms : epilepsy, convulsions, chorea, twitching. In girls, 
even very young, leucorrhcea; in boys or men, irritation of the 
ejaculatory ducts, spermatorrhoea, or masturbation. The only 
conclusive sign of worms is their passage, or a joint of them in 
the stools. 

36 



370 DISEASES OF THE ORGANS OF DIGESTION. 

Treatment. — As the presence of worms in the alimentary 
canal is an evidence of the want of tone or vigor, the greatest 
attention should be paid to the general health, clothing, bath- 
ing, diet, hygiene ; rigidly avoiding pork, starchy, or sacchar- 
ine articles of diet. Remedies calculated to give strength to 
the system, and vitalize the bowels, should be given; cin- 
chona and mineral acids, to promote assimilation ; infusion 
of golden seal, gold thread, or bayberry. This is a special 
treatment for the expulsion or destruction of the parasites. 

(1.) Ascaris Vermicularis, or Ascarides — A very common 
variety; white, and thread-like; very slender, and only from 
one-fourth of an inch to an inch in length. They possess great 
celerity in their movements, and, when touched, contract to 
about half their length. Their seat is the large intestines, 
and are most abundant near the termination of the rectum, 
although they are occasionally met with higher up. 

Signs of Ascarides. — Irritation, and intolerable itching and 
pricking sensation, and often some swelling at the extremity 
of the rectum ; occasionally congestion, even inflammation, 
and discharges of blood, with tenesmus ; often heavy muco- 
purulent leucorrhoea. 

Treatment for Ascarides. — In addition to the general man- 
agement of the case, enemas are of the greatest utility. It is 
impossible to effect a cure without them, such as injections of 
salt and water, lime-water, camphor-water, aloes, gentian, 
golden seal, etc., in infusion. Any of the above will kill and 
remove them from rectum. 

(2.) Lumbricoides resembles the common earth worm ; round 
and white, like a goose quill ; varying in length from six to 
twelve inches. Their principal seat is the small intestines, 
but they are occasionly found in the colon and rectum. 

Signs of the Lumbricoides. — Pricking and rending pain about 
the umbilicus ; colic, with rumbling noise in the abdomen, 
occasioned by the worm nibbling or irritating the mucous 
membrane with the sharp, cutting point of its head. 

Treatment of the Lumbricoides. — Our best drug is santo- 
nine, which acts upon the worm with powerful certainty. In 
the administration of santonine, always see if it is of a snow- 
white color ; if it is, it is good ; if yellow, or even slightly so, 
it is worthless — perfectly inert. It is a peculiar drug; acts 
on the brain, the coats of stomach and bowels, as a bracing 
tonic; improves assimilation, and thus aids nutrition. On 
account of its irritant action upon the brain in larger doses, 
especially upon the children of highly-civilized parents, it 
should seldom, under five years of age, be given in larger doses 
than a grain every other night ; from five to ten years of age, 
in two-grain doses. Dissolve in a little hot water; cool, and 



DISEASES OF THE ORGANS OF DIGESTION. 371 

give before retiring. Early next morning a dose of compound 
licorice powder, or neutralizing mixture, or oil, sufficient to 
move the bowels ; continue this treatment for two or three 
weeks. Santonine may chemically destroy the worm, or it may 
mechanically tear it up in shreds, which will float on top of 
water, if poured into the chamber. 

(3.) Tape Worm. — Instead of five forms of tape worm that 
are ordinarily found in man, some think the number might 
be extended to nine varieties, out of the two hundred and fifty 
that are said to exist. Although some eight or nine have been 
found in his alimentary canal, still very few have been able to 
maintain an existence there except the taenia solium, and pro- 
bably if it were not for his hooks and suckers, he would not 
long be a denizen of the human bow r els. 

The original source of origin of the tape w T orm (taenia solium) 
is from the hog. The cysticercus cullulose, or pork measles, is 
the larva or scolex of this tape worm ; consequently, it is very 
common among pork-eaters. A heat of 212° Fahr. is supposed 
to destroy the larva, but it is doubtful. At all events, imperfect 
cooking, raw or partially-cooked sausages, hams, etc., the very 
great amount of which is consumed at lunches, forms an item 
in its production. Besides, the lovers of early vegetables, as let- 
tuce, spinach, onions, cabbage, salad devotees, are great sufferers 
from this worm, as they are very generally manured from the 
contents of cess-pools, which are teeming with the ova of this 
worm. 

It is very common among the inhabitants of all cities, who 
are compelled to drink water into w T hich sewage has entered. 
Such rivers are loaded with millions of the ova of the parasite. 
We could name a city of a million inhabitants ; one hundred 
thousand of its population having each a tape worm. Now, take 
that number, each having a large cestode helminth, w r hich, in 
its sexually mature state or strobile condition, measures from 
twenty-five to thirty feet in length, and in breadth from half 
an inch to one inch, with a perfect ovarium every three-quarters 
of an inch, each one containing five hundred ova, which keep 
breaking down daily, so that every two w r eeks the entire thirty 
feet break off, and w T e have a new production. Count the ova 
that are thus passed and drank in the water that supplies such 
a city; can we wonder at the great prevalence of the parasite, 
so long as sewage is permitted to enter water to be drank by 
man or beast? 

The head or scolex is small and flattened, provided with a 
projecting papilla, armed with a double circle of hooks and 
four suckers or mouths, by which the worm attaches itself to 
the mucous coat of the bowels ; the neck, long and narrow, 
continued into imperfect segments (sexually immature), which 



372 DISEASES OF THE ORGANS OF DIGESTION. 

gradually merge into distinct segments (proglottides) or sex- 
ually mature joints. The generative apparatus consists of a 
ramified canal or ovarium, containing the ova, and of a minute 
spermatic duct, both occupying the centre of each proglottis. 
Impregnation occurs by contact of one proglottis with another. 
It is probably nourished by imbibition through its tissues, just 
as other parasites imbibe nourishment from their surroundings. 

Whether from the hog, or from water, or otherwise, the 
entrance of the ova into the human body is by the mouth; but 
the ovum will not hatch till it reaches the duodenum; in that 
delicate, velvety, eider-down bed it germinates and makes an 
attachment. Although there may be a large number of eggs 
swallowed, there is usually only one that makes it his abode. 

Sometimes the ova find their way into the blood, and, if so, 
the ovum is very liable to be hatched in the brain, which is 
often a latent cause of sudden death. 

Signs of Tsenia. — This worm gives rise to most aggravated 
symptoms — a feeling as if something was alive in the bowels, 
with a sense of weight ; bittings felt in the region of the 
stomach ; the abdomen swells and subsides at intervals ; the 
appetite is voracious ; livid complexion ; vertigo ; dilated pupils ; 
vomiting ; convulsive tremor of the body ; and if epilepsy is 
present, severe fits ; small portions of the worm pass with the 
faeces, like gourd seed. 

Treatment. — The armed tape worm is found exclusively in 
the human subject. It is difficult often to effect its expulsion, 
as it is armed with two small fangs, which enable it to hold on 
tenaciously to the mucous membrane. As every one has their 
own special formulae for its death or expulsion, a brief enumer- 
ation of the various remedies will suffice: Pomegranate root 
bark, pumpkin seeds, male ferm, kousso, kamala, etc., etc. 

The properties of each are due to an active principle called 
valdivine, and which is more abundant in the pomegranate, 
kamala, and male ferm. This is the most elegant and reliable 
of all remedies ever introduced, and very positive in its action; 
seldom, if ever, failing to bring away the worm, head and all. 

As the parasite propagates from segments of the neck, it is 
of the utmost importance in its removal to effect its entire 
expulsion, especially the head. 

TRICHINIASIS. 

A peculiar febrile helminthic affection, attended with a train 
of sypmtoms very closely resembling typhoid fever. It is 
thought to be peculiar to rats, and from them finds its way 
into hogs, and through the latter into the human body. The 
trichinae are usually swallowed in imperfectly cooked pork 
or sausage; breed in the intestines of man, and after being 



DISEASES OF THE ORGANS OF DIGESTION. 373 

hatched, migrate from the bowels to the various muscles of 
the body, and live upon muscular tissue. They are true para- 
sites. Their presence in the muscles give rise to violent con- 
stitutional disturbance. The disease is becoming fearfully 
prevalent. Scarcely a rat in our large cities free from it ; they 
often communicate the parasite to water, or are eaten by hogs; 
the flesh of the latter, and even their lard, being affected. It- 
is generally conceded that they are effectually destroyed by a 
high temperature, although some doubt even that. Smoked 
or half-cooked sausages or pork is highly dangerous. They 
contribute greatly to the dissemination of the disease. There 
can be little doubt, if this article is to remain a staple article 
of diet, that the highest kind of heat possible, without destruc- 
tion of the meat, is the only safe-guard. 

Symptoms. — These will be very variable, depending upon 
the fact whether there has been many swallowed, the number 
of their progeny, and location of their migration. They embrace, 
however, general prostration, loss of appetite, nausea, diarrhoea, 
and painful stiffness and swelling of the muscles of arms and 
legs. Pain is, no doubt, due to emigration of young trichinae into 
the muscles, their colonization, multiplication, and encystica- 
tion. Rigors, headache, high fever; ©edematous swelling of the 
face and eyelids ; frequent pulse ; copious, offensive sweats ; 
urine scanty; excess of urates and uric acid — never albumen 
or sugar ; great stiffness in joints ; pain in muscles increases, 
become painful to the touch, and greatly swollen; movement 
of intercostal muscles attended with pain ; thus preventing 
sleep ; hiccough, if diaphragm is invaded ; hoarseness and loss 
of voice, if they get into the laryngeal muscles. If a large 
number of the parasites have been swallowed, patient may 
become paralyzed, or suffer from profound exhaustion. Facial 
oedema continues for many weeks after recovery, associated or 
followed by swelling of the feet, legs, and body. If it lasts 
longer than four weeks, very unfavorable ; pulse and respira- 
tions frequent ; tongue dry and red ; pain very severe, profuse 
sweating ; mouth can scarcely be opened ; no sleep ; anxiety, 
delirium ; death preceded by exhaustion. Complications very 
often prove fatal — -peneumonia, pleurisy, peritonitis, dropsy, 
diarrhoea. 

In another class of cases, patient may die from the prelim- 
inary shock. In more favorable cases, after running three or 
four weeks, symptoms abate — parasites become encysted and 
die. AVhen the disease exists, there is not a single muscle in 
the body that is exempt from their localization. 

The young trichinae measure one-thirtieth of an inch in 
length; fully developed males, about one-eighteenth of an inch ; 
females, half that size. 



374 DISEASES OF THE ORGANS OF DIGESTION. 

Diagnosis. — The above general symptoms can be most con- 
veniently classed under four clinical types : 

1. G 'astro- Intestinal, in which the parasite burrows in the 
muscular coat of the stomach, bowels, diaphragm ; in which 
there is grave digestive troubles without any apparent cause, 
as sensations of distension, nausea, and vomiting. The time of 
vomiting varies; it may occur immediately after the trichinae 
pork has been eaten, or may be delayed several days. Usually, 
the vomiting is accompanied with diarrhoea. All those symp- 
toms may be present in indigestion. If trichiniasis be suspected, 
the diagnosis may be readily made by the discovery of the 
entozoa in the stools. If the diarrhoea be excessive, the symp- 
toms may resemble those of cholera or typhoid fever ; but there 
are two characteristics here that may precede the diarrhoea — 
excessive perspiration, and extreme muscular prostration. 

2. In this class, muscular pains predominate, even muscular 
exertion is painful, and causes fatigue. Towards the eighth 
day muscles are swollen, hard, tender, and the flexor muscles 
are always more affected than the extensors, and from the 
irritation of the muscles, shortening and contraction may result. 
Symptoms of lockjaw, difficult deglutition, due to the pres- 
ence of the trichinae in the muscles of jaws, pharynx or larynx; 
the voice may be altered, and if the parasite lodge in the inter- 
costal muscles and diaphragm, there may be difficulty of breath- 
ing. To these may be added pains, irregular in their distri- 
bution, not corresponding to the course of the nerves, which 
resemble rheumatism. Besides, there is likely to be disturb- 
ance of the stomach and bowels, which should arouse suspicion. 

3. The most characteristic is oedema or swelling. The patient 
appears with swollen face, especially the eyelids ; and there is 
great prostration. The swelling may occupy one side of the 
face, or both. This kind of swelling, with heat and urine 
normal, with muscular prostration and some gastro-intestinal 
trouble, can leave little doubt of the complaint. 

4. The typhoid form bears a strong resemblance to typhoid 
fever; there being fever, prostration, difficulty of breathing, 
and much muscular pain; still the profuse sweating, the oedema 
of the face, which is present in nine cases out of ten of trichi- 
niasis, and the very brief period of fever, which ceases while the 
other symptoms grow worse. This last is the gravest form, 
and death may occur in a few days or in two or three weeks, 
with delirium, stupor, and general symptoms of prostration. 

We have been thus particular in enumerating the diagnostic 
points, as thousands of human lives are annually sacrificed by 
this parasite, and the profession fail to recognize it. This want 
of recognition is a serious error. 

Treatment. — No reliable treatment can be laid down ; very 



DISEAES OF THE ORGANS OF DIGESTION. 375 

poor success with our best remedies ; quinine in large doses 
seeming as efficacious as our best antiseptics ; carbolic acid and 
tincture of iodine, salicylate of soda, hydrocyanic acid dilute, 
are each esteemed of great efficacy. But the best plan is to 
nurse and nourish well for four weeks, guiding the patient 
over the critical period ; let the worm encyst itself and die ; 
for this purpose, perfect rest, most nutritious liquid food and 
tonics should be given. 

DRACONTIASIS. 

Dracunculus, or guinea worm has a long, cylindrical body, 
about as thick as a crow-quill, and from one to twelve feet long. 
Usually found in the subcutaneous areola tissue of the feet 
and legs ; common in malarial or swampy sections of country. 

Symptoms. — A feeling of irritation in the affected part, 
where a cord-like ridge may be felt. There is always consti- 
tutional disturbance ; headache, rigors, fever, nausea, colicky 
pains, debility. The parasite forms a sort of bed ; its head 
causes a pustule to form in the skin, which breaks, and the 
head of the worm appears or protrudes. 

Treatment. — When head protrudes, a thread is to be placed 
around it, and rolled on a pen-handle day by day ; rolling the 
worm on it, and drawing it out gradually, until its extraction 
is complete. If it does not protrude, it should be removed by 
an incision; if possible, remove it without fracture. Wading 
in swamps, malarial, or marshy districts, or lying on the ground 
should be avoided. 

FILARIA SANGUINOSIS HOMINIS. 

Filarious disease may or may not exist with chyluria. The 
presence of this minute, microscopical, almost structureless 
worm in the human blood in vast numbers is merely the 
embryonic form of the filaria, which requires the mosquito in 
which to develop it into a sexually mature worm. The mos- 
quito, feeding upon the human blood at night, when the filaria 
are to be most generally found in the blood, become gorged 
with them. Their growth in the body of the mosquito is great, 
and when liberated from the body of its host in the water, to 
which it resorts, the trematode is thus set free, and possibly 
undergoes further development in the water, or in the human 
stomach ; for the mature worm when found in the lymphatics 
measures about three inches. Its passage into the human 
body is easily explained — either by drink or skin. Once within 
the body, it has a selective power, like the guinea worm or the 
trichinae; but, instead of the subcutaneous tissue or muscles, 
it selects the lymph channels as a habitation. Its aptitude for 
choosing the lymphatics, or lymph scrotum, is remarkable, so 



376 DISEASES OF THE ORGANS OF DIGESTION. 

that the parasite is usually found in those suffering from lym- 
phatic disease. From the present condition of our knowledge 
regarding it, which is imperfect, we are unable to give its life- 
history; its original mode of ingress; its duration of life; its 
habits; its power of sexual reproduction, and the myriads that 
do exist in an affected person ; its peculiar periodicity — none 
being present in the blood during activity, but, when rest or 
night comes on, millions can be detected. It is very singular 
that just at the time the mosquito is most active, is the period 
in w T hich they are to be found in the blood. One thing seems 
to be definitely settled, and that is, the embryonic fllaria in 
the blood is a microscopic parasite, and remains or dies such ; 
that, in order for their future development within the body, 
there must exist an intermediate state in the mosquito. What 
becomes of them in the blood streams of the body during the 
day or waking period is an unsolved problem. 

The disease is only to be found in tropical latitudes. 

More is wanting to enlarge our conceptions, not only of the 
manner in which this and other parasites may infest the human 
organism, but also of the remote effects their presence is capable 
of producing. 

CHOLERA. 

We must now realize the fact that the living germs of cholera 
are nothing more nor less than the degraded or damaged bio- 
plasm of our own bodies. It sounds harsh, or grates roughly 
on the ear, that such a malignant germ could originate there, 
even though aided by the most unfavorable insanitary sur- 
roundings; for there is little doubt that imperfect drainage, 
improper food, impure water, fasting, fatigue, intemperance, 
uncleanliness, breathing vitiated air, all aid in the production 
of the germ. From the reckless condition of modern society, 
it is a wonder that we are so free from disease-germs. There 
ought to be more attention paid to sanitary science. Many of 
our modern buildings are but murderous sepulchres, being 
contaminated throughout. The very hair in some plaster is 
from the hide of some animal that has died of anthrax. The 
atmosphere of many houses is tainted with sewer gas ; neither 
ventilation, lighting or heating have been attended to. Heated 
with dry air from cellars impregnated with disease-germs; 
water-closets in houses, the reservoirs of contagion ; the very 
earth in our large cities is contaminated. All sewers should 
empty at least five miles from human abode, and the water 
into which they empty should not be drank by man or beast ; 
all dwelling should have open fire-places, as they burn up man 
noxious poisons that would otherwise enter our bodies. 

The term cholera is applied to the presence or develop- 



DISEASES OF THE ORGANS OF DIGESTION. 6 1 i 

merit of the cholera-germ in the infant, middle aged, and as an 
epidemic — conditions of the human body in which this special 
degradation takes place, which are brought about by dimin- 
ished vitality, a lowered electrical state, abnormal meteorolo- 
gical conditions, with an absence of ozone in our breathed 
atmosphere, and other insanitary conditions. 

Cholera Infantum. — This is common among children of 
all large cities in tropical countries, between the age of four 
months and two years. Children of the poor suffer most, or 
those who are subjected to the direful influence of modern 
pestilence ; for it is really the case of the little god's kissing 
carrion — compelled to swelter in the hot, insalubrious, death- 
dealing atmospheres during the months of June, July, and 
August, the temperature ranging from 90° to 100° Fahr. 

The degradation is brought about in one or other of two 
ways : 

1. By some Shock, such as a fall, blow, rocking, concussion 
of brain, or by some reflex irritation, as teething, diarrhoea, or 
the action of some cerebral stimulant, as opium in a soothing 
cordial. 

2. By Irritation of the stomach and bowels, caused by indi- 
gestion of swill or diseased milk, giving rise to acidity, fermen- 
tation, vomiting, diarrhoea. In the former case, it is central ; 
in the latter, peripheral. In whatever manner it originates, 
the two conditions quickly coalesce, and the disease manifests 
itself as a nervous affection, with an irritation or paralysis of 
the eighth pair of nerves that supply the liver, and a chemical 
change in the secretions of the bile, which is highly acid and 
irritating to the fine, delicate nerves that supply the muscular 
coat of the bowels, which causes contraction of the muscular 
coat, giving rise to severe pain, frequent evacuations, loaded 
with the cholera germ. 

Symptoms. — Those are well defined — nausea, vomiting, 
diarrhoea, great nervous prostration, or irritability; patient 
feverish, restless; heats and colds; skin white ; sleeps with eyes 
partially open; rolls head, grinds teeth; wakes up with a 
scream ; rapid emaciation ; stools, at first greenish, become like 
chop-spinach ; and prior to each motion of the bowels, the 
child instinctively draws up its knees and cries with the excru- 
ciating spasmodic pain in the bowels, from the passage of the 
acid or acrid bile loaded with cholera germs, irritating the fine, 
delicate nerves of the bowels; the urine is very scanty and 
high-colored. As the case progresses, there is more prostra- 
tration ; the skin becomes whiter and colder, and, in bad cases, 
bluish ; the features shrunken and pinched ; greater emacia- 
tion ; breath cold, as the liver fails to secrete sugar for com- 
bustion, and the case grows worse and worse. If the patient 



378 DISEASES OF THE ORGANS OF DIGESTION. 

survives the first attack, the tubercluar diathesis is created, 
and there is a complication in the deposit and growth of 
tubercle in or on membranes of brain, in or on the mesenteric 
gland. 

The duration of cholera infantum depends very much on 
the vitality of the child, its surroundings, the capabilities of 
the mother, and denseness of population. Some cases will 
commence in June, and struggle through to September; whereas 
others, under less favorable circumstances, will be attacked and 
die in a few days. 

Treatment. — Before considering the treatment, it might be 
well to ask the question — what means have we to prevent this 
terrible scourge in all our large cities ? The insanitary con- 
duction of cities during the heated term, and the condition of 
overcrowding, does not admit of a remedy; but the vitality 
of the child and welfare of the mother can be taken care of. 
The mother is of primary importance — her health and com- 
fort ; her food should be nutritious ; her mental and physical 
powers should not be taxed; she should do everything possible 
to maintain a very high standard of health, and avoid work, 
anxiety, or any depressing influence. Menstruation and sexual 
congress should be prevented during nursing. The health of 
the little one should be promoted by fresh air, good milk, 
flannel clothing, and in an especial manner by wearing the 
flannel roller round the abdomen, until they are two years of 
age. Daily bathing, followed by friction. Cradle-rocking to 
modern infants, whose parents' nervous system has been devel- 
oped at the expense of the physical, is very hurtful. Dangling, 
shaking, or jolting is very injurious. The little one should 
be kept quiet, cool, free from jolt or motion, and from the solar 
rays. Its diet, until teeth appear, should be the mother's milk ; 
and if that is not sufficient, cow's milk, very slightly diluted ; 
no starchy article of diet permitted to be used, nor sugar in 
any form. 

As soon as the disease makes its appearance, vigorous means 
must be taken to arrest it — an emetic of the wine of ipecac, 
followed with sufficient doses of the neutralizing mixture to 
open the bowels freely, followed with lime-water and milk, 
and a plaster consisting of equal parts of pulverized alspice, 
cloves, cinnamon, peruvian bark, and a very small amount of 
capsicum, wet with venegar, spread between fine book muslin, 
and applied over entire abdomen ; taken off every three hours, 
the caked mass broken up and re-moistened with vinegar. An 
evening bath is also to be recommended; well dried and rubbed, 
and followed by inunction of several ounces of warm olive 
oil. If case does not improve, then give liver a rousing up by 
administering one or two grains of leptandra in a little com- 



DISEASES OF THE ORGANS OF DIGESTION. 379 

pound licorice powder, following it up with teaspoonful doses 
of the expressed juice of raw meat every three hours ; putting 
patient upon tincture of white hellebore, which has such an 
immense sphere of action on base of brain, eighth pair of nerves 
and liver — dose must be regulated by the physician in charge — 
and begin at once with antiseptics. From among that class 
of drugs, the ozone-water, the sulphurous acid, or tincture of 
idodine and carbolic, or the solution of chloride of lime, are 
probably the best to destroy the germ. Alkaline antiseptics, 
however valuable they may be, act rather freely on the liver. 
We cannot doubt the efficacy of the chlorate or permanganate 
of potassa, or sulphate of soda, but in few cases dare we sanc- 
tion their use ; so one of the above four must be selected, and 
administered often and with regularity. The entire success, 
or non-success in the treatment, consists in the use of antisep- 
tics and nourishments. Head to be kept cool ; socks, with dry 
mustard, to feet; fever to be controlled with aconite; any brain 
symptoms, the bromide mixture ; and, above all, keep up nutri- 
tion, confining diet to mother's milk, milk and lime-water, and 
juice of raw beef. 

If the case recovers, and means are available, the child should 
be removed to the country, away from the pestilential influ- 
ence of a large city; a tonic, antiseptic course of treatment 
carried out for some months, with such remedies as glycerite 
of ozone, ozone-water, cinchona, and aromatic sulphuric acid. 

CHOLERA MORBUS. 

This term is applied to a condition of extreme nervous pros- 
tration, with cold skin, feeble pulse, interrupted respiration ; 
cold breath ; a cadaverous appearance of face ; blue feet, hands, 
nose, ears, with nausea, vomiting, frequent motions of the 
bowels, with cramp or knotting of the intestines, and the 
cholera-germ in stools. 

In our climate, with its inhabitants suffering from an inces- 
sant nervous strain or worry or struggle, we meet with cases 
of cholera morbus in all seasons of the year, chiefly among our 
adult males, although it is more prevalent when the system is 
enervated by heat, or when there are violent transitions from 
heat to cold. Climatic changes affect those who have their 
nervous systems prostrated by overwork or anxiety; and espe- 
cially so if the stomach is irritated by offending material, as 
green or unripe fruit, some acid or acrid condition, acting 
on the stomach and liver as an irritant, or upon the brain, 
involving its base and eighth pair that supply the liver. The 
disease may be traced to other causes, but the true cause is to 
be found in a depression of the great sympathetic, eighth pair, 



380 DISEASES OF THE ORGANS OF DIGESTION. 

and brain, the spinal cord being involved to the first dorsal 
vertebrae. 

Symptoms. — It usually comes on with nausea, soreness, 
pain in stomach, vomiting, purging, which rapidly exhaust 
the patient; when, by and by, those terrible cramps or knotting 
of the intestines by spasm, the features becoming cadaverous; 
breath cold ; skin cold and clammy ; hurried or short respira- 
tion; cramps in the legs; coldness of extremities; intermitting 
pulse. 

Treatment. — This must be pursued with great energy. 
Administer at once thirty grains of bicarbonate of potassa in 
tepid water ; follow quickly with an emetic of a mixture of 
equal parts of lobelia, capsicum, and valerian. Repeat dose 
after dose, until emesis is very thorough. Use the same as 
an enema. After the stomach is thoroughly evacuated, con- 
tinue with same remedy in small doses sufficient to keep down 
spasm of the bowels. Apply artificial heat to stomach, feet, 
limbs. Open bowels either with neutralizing mixture or com- 
pound licorice powder. Commence, as soon as the stomach 
will retain anything, the tincture of white hellebore and anti- 
septics, as ozone-water, or tincture iodine, and carbolic acid 
or sulphurous acid. 

The lobelia compound is invaluable for the relaxing of spasm 
and overcoming the prostration. If, after the bowels have 
been freely moved, the stomach is still irritable from the pres- 
sence of the germs, and will retain nothing, administer the 
following: camphor, thirty grains ; capsicum, ten grains; sul- 
phate of morphia, one grain. Mix, and make ten powders; 
and, while triturating, add five or ten drops of oil of pepper- 
mint. Give one powder every half-hour. 

After the stomach has been quieted, continue with antiseptics 
and tonics until recovery is complete. 

EPIDEMIC CHOLERA. 

Human beings, whose nervous systems are devitalized by 
overwork, exhaustion, privation, anxiety, struggle for existence, 
and subjected to depressed electrical states of the atmosphere, 
extraordinary meteorological conditions, and an absence of 
ozone, have within their bodies certain living elements altered 
or degraded by those adverse conditions into the cholera-germ. 
There can be little doubt but that this germ is the modified 
living matter, either of the base of the brain, the spinal cord 
down to the last cervical vertebrae, whence emanates the sym- 
pathetic, or else the eighth pair that supplies the liver. In proof 
of this, we often find cholera-germs in those whose nervous 
systems are shattered, and who suffer from diarrhoea. Besides, 
the appearance after death points to those parts as being at the 



DISEASES OF THE ORGANS OF DIGESTION. 381 

origin of the trouble. When once developed, it is capable, like 
all other contagious diseases, of being propagated by contagion 
and infection. It is not, however, contagious in a high degree, 
but can be carried by human intercou'se, by clothing, mer- 
chandise, ships, undoubtedly often spread by water, milk. 

Symptoms. — The symptoms of this disease are divided into 
three stages, which may be classed as follows: 

1. Irritability, languor, lassitude, sleepiness, confusion of head, 
pale countenance with nausea, vomiting and diarrhoea. 

2. In addition to the above aggravated symptoms, the dis- 
charges become light-colored and serous; white flakes and rice- 
water discharges appear ; the pupil becomes contracted, spasms, 
cramps, coldness of body, with intermittent pulse. 

3. Blueness, with rigid spasm, suppression of urine, collapse. 
The general symptoms of those three stages in detail are as 

follows: copious vomiting and diarrhoea; stools are entirely 
destitute of bile, and consist mostly of water, containing large 
quantities of epithelium and albumen, resembling rice-water ; 
they contain also a large quantity of chloride of sodium ; cramps 
in muscles, causing them to contract into cord-like masses or 
knots ; spasm ; the pulse is soft and easily compressed ; varies 
from 90 to 110 ; general temperature 65° to 70° F. ; the expres- 
sion of the features is ghastly or cadaverous ; eyeballs sunken, 
glassy; cold, clammy sweat ; breath cold ; so is the tongue and 
mucous membrane of mouth ; distress at pit of stomach, with 
burning; albuminuria, suppression of urine; great thirst; circu- 
lation gradually diminished; respiration impeded; hence great 
prostration. 

The heart now becomes affected; so do the blood-vessels, 
by a spasm of their muscular coats. The sugar-generating 
faculty of the liver is suspended, so that there is an icy cold- 
ness of the skin and breath, and blueness of the lips and skin 
generally. The force of the germ-disease is on the nervous 
system, which becomes early and decidedly affected; hence the 
unnatural and whispering voice, shrinkage of the entire body, 
pinched features, and contracted pupils; muddy-looking com- 
plexion, sinking of the eyes, pupil immovable, cornea flattened. 
If symptoms are not relieved, the breathing becomes less fre- 
quent, the whispering voice spasmodic, and if the pulse is 
at all perceptible, thread-like and intermitting; circulation 
arrested from paralysis of the heart ; intellect clear ; evacua- 
tions involuntary, and not a trace of bile in the stools. If the 
patient survive forty-eight hours, and exhibit signs of improve- 
ment, he may recover rapidly if the pulse rises and the stools 
become bilious, and respiration and circulation be restored. 

But very frequently improvement is only temporary, head- 



382 DISEASES OF THE ORGANS OF DIGESTION. 

ache, drowsiness, tonic or clonic spasm, vomiting, stertor, coma, 
ushering in death. 

The appearance after death, aside from the rigid contraction 
and stony feel of the muscles are a white liver, effusion in the 
ventricles of the brain and spinal, the latter being congested 
and compressed by a serous exudation. 

Treatment. — If an epidemic prevail, the most careful san- 
itary and hygienic measures should be observed, and the very 
highest possible standard of health maintained ; the very best 
of food used; no green fruit; no alcoholic drink; no late hours; 
no mental or physical overwork; no overcrowding. The best 
preventative is small doses of sulphate quinine, and abund- 
ance of good food. On the very slightest derangement of the 
bowels — that is, nausea, vomiting, or diarrhoea, give small 
doses of the neutralizing cordial, with tincture of opium, until 
it is relieved. At the same time, apply sinapisms of capsicum 
and vinegar over the bowels and down the spine ; and, as a 
drink, give sulphurous acid in water. Any other symptoms 
should be promptly relieved, the patient kept in the recumbent 
position for a few days, and plain, nutritious food given. 

If the disease has set in, and is seen first in its premonitory or 
first stage, the patient should be put to bed in the best venti- 
lated apartment in the dwelling; its temperature kept about 
80° Fahr., and arrangements at once made to have him sur- 
rounded with dry heat, heated sand in bags. The diarrhoea 
and vomiting are evidently efforts of nature to get rid of the 
germ, and it is often a good plan right here to administer an 
emetic of equal parts of lobelia, bayberry, and capsicum. After 
it has acted, phosphate of soda in solution, so as to get the liver 
to secrete and discharge the bile ; rub abdomen and spine with 
oil of capsicum cut with alcohol, and apply artificial heat, and 
let the drink be sulphurous acid and water. 

Opium in every form is contra-indicated, because it increases 
the congestion of the cord. Large doses of bromide of potassa, 
ranging from fifteen to thirty grains, with ten of carbonate of 
ammonia, and twenty drops of tincture of calabar bean should 
be given frequently. 

If the case is more advanced, pupils contracted, spasms, 
cramps, coldness, blueness, intermitting pulse, these symptoms 
are promptly met with the following: 

Tincture of lobelia, capsicum, and American valerian, of 
each one ounce. Give a teaspoonful in water every half-hour, 
and occasionally a dose of the bromide, with tincture of white 
hellebore. Cholera-germs are difficult to destroy, but with the 
lobelia compound we have had good success. Of all drugs in 
the materia medica, it alone retrogrades the growth of the 
germ. Its properties are really incomprehensible ; it holds the 



DISEASES OF THE ORGANS OF DIGESTION. 383 

position ; no more are developed under its influence ; it gives 
nature a chance to rally to legitimate work ; every drop that 
is given benefits ; the respirations become more frequent ; heat 
increases; breath becomes warm; pulse, imperceptible at first, 
becomes wiry and full ; blueness and contraction leaves the 
surface ; the paralysis of the eighth pair is relieved ; bile appears 
in the stools ; spasm and contraction are relieved,, and the eye 
acquires its brilliancy. 

It must never be given to the point of vomiting ; its action 
must be guarded, and held on to, and persevered with, so as 
to enable the 'vital forces to recover themselves. Its action is 
immense in cholera. If sinking is threatened, compound tinc- 
ture of capsicum and quinine should be administered repeat- 
edly. Juice of raw meat, well salted, should be given often. 
If thirst is intense, iced champagne or chloride of sodium, car- 
bonate of soda and chlorate of potassa in water should be given. 
If vomiting is incessant, medicine and drink in small doses 
every few minutes, with capsicum over abdomen. Dry heat, 
in the shape of hot sand bags around the entire body of the 
patient, reaching from axillae to toes, and from the groin down 
the inner aspect of the thighs, and also along arms; while 
being changed, friction with tincture of capsicum. Hold spas- 
modic action in abeyance. As soon as stomach settles, keep 
on with juice of raw meat, and give antiseptics, as ozone-water, 
or sulphurous acid, or carbolic acid and tincture of iodine. 

In cholera the insulation of the patient is of great import- 
ance — bed in middle of the room, head to north, glass under 
feet of the bed. 

The evacuations should be removed in a bed-pan, with a 
solution of sulphate of iron, and the greatest caution should be 
exercised in diet, allowing little but beef-extract, milk and 
bicarbonate of soda, farinaceous substances, until bile appears 
in the stools. 

Convalescence should be established upon cinchona and min- 
eral acids, baths, irritating plaster the entire length of spine, 
holding on to antiseptics for four or five weeks after recovery. 

DYSENTERY. 

A specific inflammation and ulceration of the mucous mem- 
brane lining the lower portion of the colon and rectum ; attended 
with great constitutional disturbance; very severe or griping 
pains ; mucous and bloody stools, and tenesmus. 

This disease is one of the greatest scourges of our country — 
present every season of heat, and in almost every locality. 

Its predisposing causes are tubercular diathesis, weakness, 
debility, solar heat. The exciting causes are moisture, damp- 
ness, a hot, oppressive atmosphere, ice-water, carbonaceous food, 



384 DISEASES OF THE ORGANS OF DIGESTION. 

crude or indigestible food, green fruit and vegetables, alcoholic 
drinks, mental depression, malaria. 

These causes, with numerous others, do not operate upon 
the rectum and colon, but upon the liver. They cause con- 
gestion of that gland, and thus prevent or obstruct the return 
of blood from the lower bowel. There is a perfect anastomo- 
zing of the rectal and hepatic blood-vessels, so that if there is 
congestion of the liver, the blood is, as it were, dammed back in 
the rectum, cannot return to the liver, owing to this obstruc- 
tion. The living, growing germs of malaria are, above all 
things, highly irritating to the liver. Their malignant viru- 
lence is manifest upon its interstitial and connective tissue, as 
well as upon the blood. 

Symptoms. — Great constitutional disturbance in the acute 
form; rigors, headache, fever, biliary symptoms, brown tongue, 
sallow skin, conjunctiva tinged with bile, nausea, perhaps vom- 
iting ; frequent evacuations of the bowels, accompanied with 
pain and uneasiness of a griping or bearing-down character ; 
the inclination to go to stool is frequently accompanied with 
tenesmus. At first, the stools are dar 1 ", ginger-bread color; 
then mucous, thin, scanty, bloody, and often mixed with little 
hard lumps of faeces. The scanty stools give great distress ; the 
griping and straining, or tenesmus, is most excruciating, with 
evacuation; motions are often dark-colored, and peculiarly 
foetid, mixed with blood, muco-purulent matter, and shreds of 
lymph. The bladder sympathizes; micturition is frequent, 
and a constant desire to urinate ; there is strangury, or only 
a few drops coming at a time; amount of urine scanty and 
high-colored ; in some cases there are violent haemorrhages. 

It may last a few weeks and terminate in recovery, or run 
into a chronic form ; or recovery may take place with thicken- 
ing, effusion of lymph, and stricture, or gangrene of the bowel 
and death ; or the patient may succumb to the violence of the 
fever and inflammation. 

Treatment. — All cases are much benefitted by the action of 
an emetic of comp. lobelia, followed, if possible, with a bath, 
and some remedy, or combination of remedies to act on the 
liver, as comp. licorice powder or phosphate of soda, or nitro- 
muriatic acid. General treatment for fever, and administering 
green root tincture of gelsemium, aconite and digitalis, to slow 
the heart and check the blood currents ; the gelsemium to be 
given freely. Its action on the liver is most desirable. Then 
annihilate or destroy the malarial germ; for this purpose a 
few large doses of quinine, say from ten to thirty grains, dis- 
solved with a few drops of aromatic sulphuric acid in water 
every three hours, and every hour administer carbolic acid 
and tincture of iodine. To relieve that terrible pain and 



DISEASES OF THE ORGANS OF DIGESTION. 385 

tenesmus, enemata of starch and tincture of opium repeatedly, 
or else suppositories of opium; the most absolute rest in the 
recumbent position; not getting up on any consideration; room 
well ventilated ; diet, milk, lime-water and beef-tea ; hot poul- 
tices over abdomen, with opium ; interdict the use of much 
drink; mouth can be washed out frequently; if there are many 
lumps of hardened fseces or scybala being passed, a dose of 
castor oil and glycerine should be given ; if there be much 
prostration, acetate of ammonia and quinine. If the motions 
are numerous, frothy, and bloody, an infusion of bay berry 
should be given. As soon as active symptoms subside, con- 
tinue with quinine in small doses in aromatic sulphuric acid, 
and the tincture of iodine. 

Subacute or Chronic Form is usually more intractable, as there 
is often atrophy of mucous membrane, with degeneration of 
intestinal glands, or the thickened cicatrices of ulcers in colon 
and rectum, with regular periodic chills. Most cases recover 
under above treatment ; still there are a few that get well and 
relapse, become emaciated ; their fasces mixed with blood and 
pus, and very offensive, with exhaustion, tenesmus, and gen- 
eral debility, which often terminate fatally. 

Treatment. — General alterative and tonic course; an avoid- 
ance of malarial locations; warm clothing; the occasional appli- 
cation of mustard over abdomen ; the constant wearing of a 
flannel abdominal roller; very generous diet, milk, cream, 
eggs, broths; perfect rest; suppositories of opium and tannin; 
try the quinine and carbolic acid and tincture of iodine first ; 
if it fails, then infusion of bayberry and crane's-bill, or logwood 
and kino, or the sulphate of alumina in tincture of iron. If 
there is any hepatitis, nitromuriatic acid in cinchona; any 
peritoneal irritation, opium; if constipation be troublesome, 
cascara sagrada. Other symptoms to be treated on general 
principles, watching the case closely from day to day. 

INFLAMMATION OF THE RECTUM. 

Rectitis or inflammation of the rectum may take place with- 
out the condition of dysentery. True, it is a rare form of dis- 
ease, but it can be produced by violence, or the introduction 
of foreign bodies into the rectum. 

Symptoms same as dysentery. There is, however, more 
intense heat and soreness about anus : severe pain shooting up 
the back and sacrum ; spasmodic contractions and excessive 
tenderness of the sphincter ani; tenesmus, with passage of 
muco-purulent matter or blood; irritable bladder; constitu- 
tional disturbance. 

Treatment. — Rest in bed ; milk and farinaceous diet; opium 
and starch ; enemata or suppositories of opium ; mustard over 

37 



386 DISEASES OF THE ORGANS OF DIGESTION. 

abdomen, followed by hot poultices ; otherwise same treatment 
as dysentry. 

STRICTURE OF THE RECTUM. 

During dysentery or inflammation of the rectum, lymph is 
often effused about two inches and a half from the verge of 
the anus, or right at the site of the tenesmus. It may involve 
an entire ring or only half, or it may be more extensive; if it 
follows deep or extensive ulceration, and is thrown out in the 
process of cicatrization, it may be quite extensive, and cause 
a narrowing and induration of the whole gut round and round, 
and some distance vertically. 

Symptoms. — Constipation; stools passed with great diffi- 
culty, in small, flattened, chopped-off pieces, from one to two 
and a half inches in length ; very severe straining efforts in 
voiding motions if solid ; pain in the loins and sacrum ; flatu- 
lence; often mucous discharges stained with blood; if ulcera- 
tion takes place above stricture, burning pain and tenderness 
about sacrum and fundament ; discharges of blood and pus. 
The reflex symptoms are often very great: headache, constitu- 
tional disturbance, impairment of health, and depression of 
spirits; heats and colds, hypochondriasis, etc. 

It must be distinguished by the history of case; the constric- 
tion (after bowels has been opeDed) should be made out with 
the finger, so as not to confound it with spasmodic constriction 
produced by sacral or lumbar irritation. 

Treatment. — The patient should be instructed as to every 
possible means of maintaining a high standard of health, by 
daily bathing, flannel clothing, and a most generous diet; 
then placed upon a general alterative and tonic course ; in the 
former using absorbents, as iodide of potassa, iodide of sodium 
alternately ; the stools rendered soft and liquid by a dose of 
oil and glycerine before retiring at night. Then the introduc- 
tion, about twice or thrice a week, of a metallic bougie, warmed 
and smeared over with an ointment of belladonna and iodide 
potassa, of a size that will pass easily through the stricture, 
and allowed to remain for over half an hour. The bougie 
should be ten or twelve inches long, and inserted gently up for 
six or seven inches, and gradually increased in diameter until 
the largest sizes pass easily. Take about three or more months 
if stricture is dense. Besides, suppositories of opium, bella- 
donna, and iodide of potassa are to be used every night, or 
oftener, if patient can spare time to lie down. This is the best 
method of cure; it is not to be dilatation, but an absorption of 
the effused lymph. No other method of any value in organic 
stricture. 

It is useless to experiment with sponge-tents, or to torture 



DISEASES OF THE ORGANS OF DIGESTION. 387 

the patient with dividing it by incision ; or to burn it out with 
the galvanic cautery ; or, by the more barbarous and less effi- 
cient mode of lacerating or tearing by forcible dilatation ; there 
is no success, no merit, no good in these, and they should not 
be resorted to. 

ULCERS OF THE RECTUM. 

(1.) Chronic Ulceration, with Thickening of the Coats of the 
Rectum, may be the result of chronic inflammation, with effu- 
sion of lymph, or it may be due to the deposit of the germs 
tubercle, syphilis, cancer, or other morbid germs. 

(2.) Irritable Ulcer of the Rectum, or Fissure of the Anus. — 
This is very common among children and ladies ; looks like a 
very slight affection, but causes great suffering, and often con- 
vulsions. Ulcer generally superficial, about one-eighth of an 
inch broad, and one-third or one inch long, seated at the anus 
generally opposite coccyx. In children reflex symptoms are 
often bad ; in women it causes ovarian irritation, irritability 
of bladder, and pain during sexual intercourse. Passage of 
stools irritates the sore, and causes spasm of the sphincter ani, 
and acute burning pain, which lasts some hours. 

(3.) Rodent Ulcer. — This coroding or eating ulcer, is usu- 
ally met with at the margin of the anus, the sore gradually 
creeping up. 

Treatment. — In all cases, the general condition of the pa- 
tient is to be attended to, nourishing food, daily bathing, warm 
clothing, and bowels kept loose with oil and glycerine, and the 
patient placed upon vegetable alteratives and tonics. The 
bowels should then be freely opened with castor oil, the patient 
placed under the influence of an anaesthetic, and a speculum of 
the proper size with a window in it should be introduced, sore 
cleansed, and touched with a potential caustic, C P nitric acid, 
say three times. Then apply extract of belladonna rubbed up 
in vaseline to the anus three times daily, and produce parlysis 
of the sphincter. At the same time lock up the bowels for a 
week, with sufficient doses of opium, and thus make an effort 
at healing. Failing in that the belladonna must be kept 
applied, bowels kept soluble, and belladonna suppositories, 
introduced into the rectum every night, depending upon active 
constitutional measures for a cure. 

PROLAPSUS OF THE RECTUM. 

Prolapsus of the rectum, or falling of the fundament or pro- 
trusion of the lower bowel, may exist in various degrees: it 
may be a protrusion only of the mucous membrane of the 
rectum, or the various coats of the bowel, or the bowel itself 
may be protruded several inches. 



388 DISEASES OF THE ORGANS OF DIGESTION. 

The cause is debility or weakness of the bowel — inherent 
loss of tonicity in its various coats, especially in its erectile 
muscular fibres. This may be brought about by diarrhoea, or 
looseness of the bowels, dysentery, or blood flux ; by the irri- 
tation of worms, prolonged constipation, straining at stool, 
disease of the urinary organs, frequent micturition, stone in 
bladder. 

Symptoms. — Usually the prolapsus at first only takes place 
after the bowels act. Gradually, however, the descent follows any 
exertion, as running, jumping, coughing, laughing, straining, or 
crying. Only a fold of mucous membrane at first, but by and 
by the inverted bowel is protruded to the extent of five or six 
inches. This may only occur after defecation, and it may be 
easily returned ; but after a while the sphincter ani becomes 
greatly relaxed, and the prolapsus becomes constant ; the intes- 
tinal mucous membrane being exposed to the air, and other 
sources of external irritation, becomes thickened or indurated, 
and sometimes ulcerated ; discharge of mucus tinged with 
blood ; a general distress about hips, back, with severe pains 
in defecating ; reflex symptoms distressing ; white face, indi- 
gestion, nervous twitching. 

Treatment. — The first thing to do is to replace the bowel, 
which is usually easily effected, if the sphincter ani is not 
irritable, nor the coats of the bowels congested. If these 
two things have taken place, it may be necessary either to 
inhale a few drops of chloroform, or apply a poultice of lobelia 
and belladonna for a short time ; then with the back of the 
hand well oiled, the bowel is easily replaced. When returned, 
it is to be kept in its place by applying a pad of lint, and 
drawing buttocks firmly together with a broad strip of adhe- 
sive plaster, or by the pad and a T bandage ; castor oil and 
glycerine to be given at bed-time, and the patient made to pass 
thin stools in the recumbent position, so as to prevent strain- 
ing. Immediately after defecation, a cold water hip-bath for 
several minutes. The general health is to be improved by 
every possible means; quinine and aromatic sulphuric acid, 
sulphate of cinchonine, compound tincture of bark, bayberry, 
etc.; very best of food, bathing, warm clothing; astringent 
enemata of decoction of oak-bark, matico, alum, before and 
after every motion ; a suppository of tannin and cocoa butter 
as soon as retired to bed. 

If medical treatment fail after a fair and prolonged trial, 
administer a large dose of castor oil at night ; next morning, 
after bowels are thoroughly emptied and returned, introduce 
an anal speculum with a window its entire length up the 
rectum ; wipe the surface clean and dry; then take C. P. nitric 
acid, and paint a line half an inch wide down the entire length 



DISEASES OF THE ORGANS OF DIGESTION. 389 

of the window once, twice, thrice ; hold, a minute ; turn speculum 
about half an inch ; wipe clean, dry, and apply the nitric acid 
again in the same manner, and repeat until it is performed 
seven or more times — that is, seven distinct streaks or pillars. 
A species of plastic inflammation, or lymph exudation, takes 
place, thickening, and they resemble so many vertical supports 
or props. To render this radical or sure method successful, 
the patient must lie in bed over a week, eat very nutritious 
but concentrated food, and take one grain of opium every three 
hours to arrest all movement of the bowels, and when unable 
to hold out longer, a large dose of oil. This is the safest and 
most successful method of cure. 

POLYPUS OF THE RECTUM. 

Polypoid growths in the hollow organs of the body are com- 
mon among those of a tubercular diathesis, brought about by 
irritation. They are usually either soft, gelatinous or villous, 
or of the fibroid form. 

Symptoms. — Uneasiness about fundament ; frequent desire 
to go to stool ; mucous discharge, tinged with blood. There is 
more haemorrhage in the villous form ; they often protrude 
when bowels is moved. 

Treatment. — If within reach of a ligature, apply one, and 
cut off with the scissors on the side of the tumor, allowing 
the ligature to slough off. Enemata of water, medicated with 
sulphate of iron, often cause the gelatinous ones to disappear. 

Rectal Neuralgia, — Is usually severe, and is often mistaken 
for spasm of the sphincter, as it usually gives rise to pain in 
defecation, and if the finger is introduced it grasps it tightly. 
In neuralgia the pain is often excruciating , there is also tenes- 
mus. The causes are obscure; it can be traced to disease- 
germs in the blood, to irritation, abortions, etc. 

To be cured by nourishing food, alteratives and tonics, 
enemata of marshmallow and conium, belladonna supposi- 
tories, quinine, nux and camphor, and improvement of general 
health. 

Cancer of the Rectum. — May be of the scirrhus, medullary, 
colloid or epithelial form. 

Is very easily recognized by the cachexia, the early prostra- 
tion, the pain, anterior and posterior, the appearance of the 
bowel to the eye, or by the touch, the discharge, the cancer 
cells, its peculiar fcetor, and, when well established, haemor- 
rhages, with loss of flesh and great exhaustion. 

Treatment. — General treatment for cancer, and suppositories 
of the ozone cancer-plaster, which kills the cancer and does 
not touch the normal tissues ; when exfoliated, iodoform sup- 



390 DISEASES OP THE ORGANS OF DIGESTION. 

positories. Pain must be relieved with opium, hypodermic in- 
jections of morphia and conium. 

HAEMORRHOIDS OR PILES. 

A varicose condition of the veins of the rectum. The cause 
is inherent or acquired debility or weakness of the veins. 
Walking, constipation, pregnancy, standing, drugs, such as 
aloes, etc., are exciting causes, together with an almost inva- 
riably present torpor or inactivity of the liver. They are 
divided into external and internal, blind and bleeding. 

(1.) External Piles. — Consist of one or more or an aggrega- 
tion of varicose veins, external to the sphincter ani. The knot 
may be soft and contain fluid blood, or the blood may have 
coagulated, forming afirm, dense, purple swelling, or the blood 
may have been absorbed, leaving nothing but hypertrophied 
skin and areolar tissue. 

Symptoms. — If they are soft and bleed in the act of defeca- 
tion, then they are bleeding piles ; if they are a mass of veins 
whose contents are absorbed, filled up and coated over with 
lymph, and do not bleed, they are blind. Both are trouble- 
some, from their bulk and location. If congested they are very 
painful, hot and throbbing. They give rise to tenesmus, irrita- 
bility of bladder, and uterine irritation in women, and such 
reflex symptoms as headache, etc. 

(2.) Internal Piles. — Are either bleeding or blind ; consist 
of knots of varicose veins, or their degenerated structure, within 
the sphincter ani; likely to protrude during defecation, but as 
the case becomes chronic the sphincter muscle loses its tone, be- 
comes relaxed ; they may protrude at all times. If they are 
filled with blood, likely to be haemorrhage. There is itching, a 
sense as if some foreign body was in the rectum with un- 
easiness, tenesmus, irritability of bladder ; or, if in women, 
of the uterus, muco-purulent discharge, debility, loss of flesh, 
anaemia, sallowness of complexion, derangement of the func- 
tions of the liver, stomach and bowels. 

Treatment. — In both external and internal piles of either 
class, the main object, in correct treatment, is to remove the 
congestion of the liver and build up the general health. For 
removing torpidity of the liver a well-regulated but nourishing 
diet, free from highly seasoned food and all kinds of alcoholic 
stimulants. Sulphur is an important remedy, one of the very best 
to keep up an active biliary secretion, the flowers of sulphur, 
compound licorice powder, tincture of sulphur. Our next best 
drug is tincture of mix vomica, chionanthus virg., kurchicine. 
Bowels to be opened every morning with enemata of cold water 
and extract of hamamelis, or tincture of perchloride of iron. 
If bleeding and internal, suppositories of the perchloride of iron 



DISEASES OF THE ORGANS OF DIGESTION. 391 

every night at bedtime causes them to rapidly shrivel up and 
disappear ; if they are blind and internal, suppositories of iodo- 
form will cause their absorption; if external and bleeding, 
an ointment of the perchloride of iron will arrest it; if blind, 
iodide of potassa in belladonna ointment will cause their 
absorption. With those remedies, a little time, patience and 
perseverance, there is no need of the barbarous treatment by 
caustics, excision, scoops, ecrasement, ligation. During treatment 
a general tonic course and the persistent use of hamamelis, 
with every possible means of improving the general health. 
Cold water hip-baths are not to be overlooked. 

FISTULA IN ANO. 

Anal fistula is very common, and consists of a tube or pas- 
sage lined with a false membrane, which is a secreting tissue, 
and communicates with a cavity. It is met with in three 
forms — complete, blind internal, and blind external fistula. 
A complete one is when a probe can be inserted through the 
external opening straight into the bowel ; blind internal, when 
inflammation has followed the body a certain length, and 
closed the internal opening, and left the outer ; and blind exter- 
nal, when the mucous and other coats of the bowel have been 
perforated, the body proceeded some length, and either been 
regurgitated or dissolved, and left an opening down into the 
tissues, but does not penetrate the skin externally. 

Causes. — Constipation, which distends the lower portion of 
the bowel to a great extent, and then a piece of hardened fseces, 
fruit-seed, fish-bone, or some other hard body excites irritation, 
inflammation and ulceration clean through, or otherwise form- 
ing a sinus, or fistulous ulcer. There may be one or half a 
dozen. Fistula does not necessarily either co-exist or depend 
upon tuberculse. The tissues of a tubercular subject are soft 
and less vital, and the irritation of a body ulcerating through 
may attract germs, but it has no real bearing in the case. 

Symptoms. — The external aperture is usually small, and 
sometimes difficult to find. It is generally near the anus, but 
it may be one or two inches distant ; it may be concealed in a 
furrow, or will be found in the centre of a button-like eminence. 
Complete fistula most annoying, because gas, intestinal mucus, 
and fluid faeces pass along its tract, causing external irritation, 
and painful spasmodic contractions of the sphincter. 

Treatment. — Whichever of the following methods may be 
decided on, first of all improve patient's health by inculcating 
good bathing, etc. Then cleanse out the bowels with oil, and 
select one of the following : 

(1.) Caustics. — A large percentage of cases can be cured by 
caustics, as emptying C. P. nitric acid into the tract by means 



392 DISEASES OF THE ORGANS OF DIGESTION. 

of a deep-grooved rod, or making a tubular stick of chloride of 
zinc and flour, and inserting the whole length of tract, or the 
wire of a galvanic cautery. The bowels are to be locked up 
for a week or longer with opium, and patient to be kept quiet 
in recumbent position, and when bowels are opened, motions 
to be procured by oil. The success of this plan depends upon 
the effusion of plastic lymph to block up tube. Worthy of trial. 

(2.) Ligature. — Seven threads of saddler's silk introduced 
through the fistula into the bowel by a flexible probe, brought 
out and tied upon a cork, and tightened daily, is a most effectual 
plan, as the effusion of plastic lymph follows the ligature, and 
the integrity of the sphincter ani is preserved intact. It takes 
from five to ten days to cut through or longer. 

(3.) The Ecraseur. — To insert the chain of the ecraseur up 
through the fistula by a thread, and crush the parts, prevents 
haemorrhage taking place in their division ; but often, very 
olten, the sphincter muscle of the rectum never unites, and the 
patient is in a very unpleasant situation. 

(4.) The Knife. — This is used without ever estimating the bad 
results that are likely to follow. The fistula is divided into 
the anus, sphincter and all. The trouble here, if the patient 
is in feeble health, is the sphincter does not unite, and the 
patient loses all control of his bowels. If the patient is very 
vigorous, union may occur. 

The use of the catgut, or elastic ligature and other means, 
are unworthy of notice. If there are several fistulas, they can 
be operated on at the same time. 

The ligature is a little more painful, but is the safest, and 
always attended with the most happy results. 

There are various other morbid states met with in and about 
the rectum and verge of anus, such as gonorrhoea of the rectum, 
venereal warts, condylomata puritus, which are described in another 
portion of this work, and are to be treated on general principles. 

Besides, we often meet in prostitutes with poor constitutions, 
who are compelled, through extreme destitution, to eat bad, 
meagre or insufficient food — who indulge in alcoholic drinks, 
or have been mercurialized, or subjected to the depressing 
effects of insanitary surroundings, most destructive ulceration 
(phagedenic) of the skin and cellular tissue adjacent to the 
rectum. This gangrenous inflammation often produces exten- 
sive devastation of the tissue. The germ here is the oidium 
albicans, the evidence of squalor and human rot, and for their 
destruction and repair, we need powerful germicides and reme- 
dies to reconstruct shattered vital force. 

Locally, charcoal, yeast, wild indigo, and carbolic acid in 
poultices, with washes of boroglyceride. Internally, best of 
diet, quinine, kephaline, ozone-water, country air, etc. 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 393 



DISEASES OF 
THE LIVER, PANCREAS, AND SPLEEN, 



ACUTE INFLAMMATION OF LIVER. 

Hepatitis. — Partial death of the liver may result from some 
obstruction through the hepatic and portal veins, as occurs in 
some forms of valvular disease of the heart, or morbid state of 
lungs, impeding the passage of blood through the pulmonary 
artery; or in diseases that diminish the capacity of the tho- 
racic cavity ; or from violent exercise, or tight lacing ; condi- 
tions that lead to diminished excretion of bile, so that the ducts 
become engorged with it, and thus cause biliary congestion. 

Suppose this condition to progress, the patient receiving 
some mechanical shock over the liver, or that some diseased 
germs in the blood took up their abode there, or that it was 
subjected to the influence of solar heat, malaria, or to some 
depressing passion or other nervous influence, or excessive 
eating and drinking of carbonaceous food, as fat, sugar, starch, 
alcohol, with sedentary habits, a state of active congestion will 
set in ; other conditions might be enumerated, as the action of 
mercury, which produces atony of the walls of the vessels of 
the liver. 

From these remarks it will be readily seen that the causes 
of acute inflammation of the liver are varied and numerous, 
embracing mechanical irritation, obstruction from morbid 
changes, heat, malaria and other germs, carbonaceous food, 
drugs, mental depression ; in other words, anything that tends 
to devitalize. 

Symptoms. — General symptoms of languor, lassitude, de- 
bility, mental depression, loss of appetite or dyspepsia, tongue 
coated heavy brown coat, skin jaundiced, yellow conjunctiva, 
bowels constipated or irregular, a sense of constriction and 
weight over liver at first, it greatly enlarges from congestion, 
and the area of hepatic dullness increases; liver extends below 
the ribs and across the hypogastrium ; headache, pain in back, 
calves of legs, rigors, followed by high fever, which sometimes 



394 DISEASES OP THE LIVER, PANCREAS, AND SPLEEN. 

assumes a low type; pain over region of liver, aggravated by 
pressure ; cough, deep inspirations, inability to lie on left side ; 
the coat on tongue becomes heavier, conjunctiva tinged with 
bile ; there is nausea, vomiting, cough, difficulty of breathing, 
hiccough, pain in right shoulder and clavicle ; if the left lobe 
of liver suffers there may be pain in the left shoulder, dullness 
of the upper lobe of left lung ; urine is always scanty, high 
colored, loaded with bile pigment and traces of albumen. The 
variation and intensity of symptoms will depend a good deal 
as to whether the peritoneal investment or substance of the 
gland suffers most. Most generally it is the substance of the 
gland that is affected. 

If the inflammation or partial death is great it may lead in a 
short time to extravasation of blood into the hepatic tissue, or 
beneath the capsule, the result of great congestion, as takes 
place in bilious, malignant, remittent, or yellow fever. The 
extravasation may be from the size of a pea to that of a duck 
egg ; in some cases the blood is infiltrated through its entire 
substance, converting the tissue into a pulpy mass. In less 
severe cases, even with the morbid action diffused through the 
entire organ, effusion of lymph may take place, which may 
lead to induration, with atrophy or enlargement, and ultimately 
softening or abscess. 

The formation of abscess is ushered in with distinct chills 
after the inflammatory stage has proceeded some time, with hec- 
tic fever, great disturbance of the stomach, with extreme pain 
and tenderness over both liver and stomach and abdominal 
walls; feeling of weight about the liver, emaciation, prostra- 
tion, diarrhoea or dysentery. 

Treatment. — Inculcate the general principles of treatment 
for fever, complete rest in bed, sponging the entire body three 
times daily with some aqua ammonia and tepid water, dry- 
ing and rubbing well, and then sponging with nitromuriatic 
acid water, heat to feet ; first apply a large mustard plaster 
over region of liver and stomach, and as soon as erythema 
or redness is produced, paint over the inflamed part with cro- 
ton oil, and over that a hot flaxseed-meal poultice; change 
poultices every three hours. As the stomach is irritable, lime- 
water and milk ; control fever with very large doses of the 
tincture of green root of gelsemium with veratrum and aconite ; 
as soon as pulse is about 70 leave veratrum and aconite out, 
and hold on to gelsemium; as soon as stomach will contain drink, 
oatmeal-gruel and phosphate of soda, and six-drop doses of 
nitromuriatic acid in water every three hours. If stomach is 
persistently irritable use small quantities of ipecac and mor- 
phia ; if there is dysentery give one or two large doses of qui- 
nine, and to render the stomach more tolerant add about a 



DISEASES OF THE LIVER, PANCKEAS, AND SPLEEN. 395 

grain of pulverized opium to the dose ; get control of the more 
acute symptoms, and never mind diet, and even when given it 
must be greatly restricted. If there is constipation, enemata, 
or a small dose of compound licorice powder, or a drink of the 
acid tartrate of potash. 

Great care and good discrimination are necessary in the 
selection of the proper remedy and dose. 

If case progresses favorably, establish convalescence upon 
compound tincture cinchona and nitromuriatic acid, fluid 
extract of chionanthus virg., and nux, or leptandra and salines. 

If Suppuration take place, support the powers of life with 
most nutritious food, cinchona and mineral acids, quinine; 
poultice assiduously. The peritoneal coat of liver becomes ad- 
herent to the abdominal wall at points, and, as a general rule, 
it is best to let it burst spontaneously; they do better than those 
that are punched by grooved needles, or trocar and canula, or 
even the aspirator. 

CHRONIC INFLAMMATION OF THE LIVER. 

Chronic inflammation of the liver may be a sequel of either 
active or passive congestion ; it may present itself with either 
hypertrophy or atrophy, but in either case indurated or hard. 
Various names have been applied to it, as indurated liver, 
interstitial hepatitis, granular liver, gin-drinker's liver, hob- 
nailed liver, from the fact that the capsule of the gland is 
drawn in here and there over it, owing to contraction of thick- 
ened connective tissue, giving it the appearance of hob-nailed; 
and some call it cirrhosed liver, because on slicing it after 
death, it presents the grayish yellow color of impure beeswax. 
The term chronic inflammation is the best, 

Causes. — Solar heat, malarial germs, carbonaceous food, dis- 
ease of heart, lungs, etc. ; mental depression, articles of dress, 
as tight lacing, violent muscular exercise, use of mercury, 
whisky or beer, which retards its function, and excites irrita- 
tion directly in its substance ; impure air, inattention to bowels 
and skin, want of exercise. 

Symptoms. — There is a general lethargy of the entire body ; 
skin is sallow — in rare cases slightly jaundiced ; the white of 
the eye tinged with bile; tongue coated with white and brown 
coat ; breath fetid; copper taste in mouth; usually constipation 
and clay-colored stools ; urine scanty, high-colored, with bile 
pigment and traces of albumen ; skin is dry and harsh, burn- 
ing in hands and feet ; often sweaty feet, with pungent odors ; 
sebaceous glands of nose, axilla, groin, active, giving those parts 
a greasy feel ; skin not only sallow, but assumes an unhealthy 
look. After disease has lasted some time, dyspepsia, flatulence, 
constipation, with feverishness by spells and headache. There 



396 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

may be nausea or loathing of food — a sense of constriction and 
weight over liver; there is an increase or decrease in size, 
usually the former, from effused lymph in its interstitial struc- 
ture. This lymph blocks up, interferes with the flow of portal 
blood and escape of bile. In enlargement, area of dullness 
greatly increased; if it contracts and lobules atrophy, the gland 
diminishes in size ; piles, enlargement of spleen, pain, perhaps, 
over region of liver; if not, then it will be experienced in right 
shoulder and clavicle. Passive congestion of the upper lobe 
of right lung, and dullness on percussion; irritative cough. 
As the case progresses, symptoms become more aggravated, 
and debility, with loss of flesh, takes place. An increasing 
contraction or obstruction from effused lymph takes place, and 
damms back portal circulation, and ascites supervenes. Jaun- 
dice is now decided ; dilatation, of the veins of abdominal walls ; 
haemorrhage from nose, stomach and bowels often present ; 
indeed, a bleeding from nose and stomach might be an early 
symptom, and often occurs before the disease is suspected. 

After the disease has lasted from a few months to more gen- 
erally ten or twenty years, the debility and anaemia become 
great, dropsical effusions in the abdomen and limbs increase, 
and death takes place either from exhaustion or some compli- 
cation, as pneumonia, peritonitis, jaundice, toxaemia, diarrhoea. 

Treatment. — Medical statistics exhibit the fact that nearly 
two-thirds of our entire population, young and old, men and 
women, are affected with chronic inflammation of the liver. 
Now, this is due in a very great measure to our hot, or tropical 
climate, malarial atmosphere, excessive struggle or brain work, 
whisky and beer-drinking, hog-eating, starchy and saccharine 
feeding, tobacco-chewing, mercurial drugging. Our first aim 
in a cure, therefore, consists in discarding all these agents; for- 
bid mental anxiety, a total disuse of fat, sugar, starch, whisky 
or beer, tobacco, mercury, etc.; and besides, tea, curry and 
all high-seasoned dishes. Plain animal food, milk, eggs, white- 
fish, fruit, and vegetables ; daily bathing, flannel clothing, open- 
air exercising, horse-back exercise ; well ventilated apartments ; 
bowels to be opened once or twice daily; irritating plaster to 
be worn pretty steadily over liver; an alterative and tonic 
course inculcated ; such alteratives as saxifragica, tag alder, 
alums, comfrey, dulcamara, elecampane, blue flag, leptandra, 
podophyllin, stillingea, iodide of potassa, and iodide of sodium ; 
and as tonics, cinchona, mineral acids, hydrastis, columbo, 
collinsonia. Besides general alteratives, all bearing upon the 
liver, stimulating a renewal of life in that gland, the tonics 
should be selected with the same view, the alteratives admin- 
istered two hours after meals, and the tonics half an hour 
before — both freely diluted with water, and changed weekly. 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 397 

Digestion should be looked to, and gentian and pepsin and 
other remedies to strengthen the stomach. The special reme- 
dies that stimulate the liver, break down and absorb lymph, 
can usually be run in either in the alterative or tonic form, 
such as 

Phosphate of Soda: Used in all articles of diet instead of com- 
mon salt, is invaluable in promoting a free flow of liquid bile; 
it should never be omitted in treatment. 

Nitromuriatic Acid : One of the very best of liver stimulants, 
in six-drop doses in compound tincture cinchona ; used for 
about a week, discontinued for a few days, and then re-com- 
menced; its action on the connective tissue of the liver is 
invaluable. 

Sulphur: Always and persistently from one form to another; 
an invaluable liver stimulant. 

Chionanthus Virg., or fringe tree, is superior to all vegetable 
liver stimulants ; much superior to mandrake, blue flag, lep- 
tandra, taraxacum ; very mild in its action. Phytolacca is 
an admirable cholagogue in small doses. 

Nux vomica is not to be discarded. Iodide potassa, ozon- 
ized glycerine, ozone-water, should be given all through the case. 

Id addition to the special treatment for rousing up the liver 
with special remedies, I have found the use of the white mus- 
tard seeds of great value in doses of from one to two teaspoon- 
fuls of the seeds whole — never pulverized — in a little water or 
mucilage one hour before each meal. It is an invaluable 
remedy when the liver and stomach are sluggish — when there 
is great debility, loss of appetite, failure to sleep, depression of 
the nerves. The mustard seed gives new life to the liver ; pro- 
motes a good biliary secretion. In that form of chronic inflam- 
mation of liver due to the use of whisky, and when the stomach 
coats are pretty well eaten, it can be used with splendid suc- 
cess. In the malarial form its action is beyond description. 
Its use should be continued for six or more months after 
recovery has taken place. 

Kurchicine is another remedy of inestimable value in the 
chronic inflammation of liver due to heat, malaria, and car- 
bonaceous food or drink. It is extensively used for those 
terrible forms of bilious fevers so common in the swamps of 
Hindostan. 

When Degeneration of Hepatic Cells is suspected, iodoform 
ointment instead of irritating plaster, ozonized glycerine and 
water, nitromuriatic acid; and if stubborn, apply ozonized clay. 

If there is Hemorrhage, the sulphuric acid and turpentine 
mixture, gallic acid. 

For Ascites, general treatment for dropsy — digitalis, squills, 
pilocarpin, diaphoretics, diuretics, etc. See Dropsy. 



398 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

SYPHILITIC HEPATITIS. 

This is not confined to any particular stage of syphilis. 
Let the germ enter the body of a person with a weak or devital- 
ized liver, the first thing we often observe is syphilitic hepa- 
titis. As a rule, the syphilitic germ does not manifest any 
special preference for the liver, like the skin or mucous mem- 
brane ; it does not seem to be a pleasant or congenial pasture- 
field. When it takes that organ for its abode, it colonizes in 
three forms : (1) germs generally diffused through interstitial 
structure ; (2) a large congregation of germs, colonies varying 
in size from a linseed to a bean ; (3) in large, irregular patches. 

Symptoms. — Sometimes there are all the indications of 
chronic inflammation of the liver ; in other cases, there are 
few, if any, symptoms present but jaundice, a coppered-colored 
appearance of mucous membrane, with other marks of syphi- 
litic cachexia, enlargement of spleen and albuminuria. 

Treatment. — General treatment for syphilis, keeping bowels 
open, and using alkaline baths, nourishing food, rest from bodily 
and mental work, country air, etc., and treatment for chronic 
inflammation of liver. 

DISEASE OF THE BLOODVESSELS OF THE LIVER. 

The hepatic artery and its branches may be involved in chro- 
nic inflammation, deposit of the germs of cancer, syphilis, and 
tuberculse ; the canal of the artery may be obstructed, or there 
may be degeneration of its coats, or it may be dilated into 
aneurismal sacs. 

Portal vein may have its channel obstructed by coagula ; 
sometimes ruptured from fatty or calcareous degeneration of 
its coats, inflammation, ulceration or suppuration of viscera, in 
which the roots of this vein have their origin, may produce 
suppurative disease of the vein itself. 

Symptoms. — Headache, rigors, violent fever, great prostra- 
tion, profuse sweats, pain in the stomach and over the region 
of the liver, jaundice, bilious diarrhoea, or enlargement of liver 
and spleen, followed by peritonitis or purulent deposits in joints, 
lungs and glands, terminating in fatal exhaustion or coma. 
Remedies of no avail ; mitigate suffering, and support the failing 
powers. Hepatic veins are found enlarged after death in all 
cases of valvular disease of the heart ; rarely the seat of inflam- 
mation. 

Inflammation of Gail-Bladder. — The gall-bladder and bili- 
iary ducts may suffer from inflammation from a variety of causes, 
as congestive chills, mechanical irritation,as dress,drugs, alcohol, 
beer, etc., morbid state of the stomach and bowels. It is apt 
to assume one or other of three forms. (1). Catarrhal, in which 
the internal lining membrane of the ducts throw out a secre- 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEX. 399 

tion of mucus or muco-purulent matter ; the cyst liable to be 
blocked up with such mucus. (2). Plastic exudation, in which 
the passages or tubes are blocked up by plastic lymph, which 
leads to dilatation. (3). Suppurative inflammation, usually due 
to the presence of gall-stones, hardened bile, and gives rise to 
ulceration in a variety of forms. 

These three states may exist all over the net- work of hepatic- 
vessels, although they arc more commonly met with at the ter- 
mination of the excretory duct of the liver and gall-bladder. 

Symptoms. — These are very variable, but embrace the prin- 
cipal or leading features of chronic inflammation of the liver. 
Still, as the gall-bladder, cystic and common ducts are more 
obnoxious to inflammation than the hepatic ducts, as the former 
are more likely to be irritated by gall-stones and pieces of dried 
or hardened bile, the difficulty can be appreciated by a localized 
irritation over the seat of those ducts, as well as by tenderness 
over the part, or sense of tightness or constriction over the 
stomach and liver ; nausea, constipation and jaundice, due to 
absorption of bile ; pain in shoulder, fever, headache, etc. 

Treatment. — Very much the same as for chronic inflamma- 
tion of liver, same diet, baths, and other remedies, watching 
the case carefully, using no drastic cathartics. 

DEGENERATION OF THE LIVER. 

There is an inherent tendency in a liver that has, or is 
suffering congestion, active or passive, or acute and chronic 
inflammation, or a partial death from any cause, to undergo 
degeneration ; that is, for its proper structure to waste, or to in- 
crease in size, or to be usurped by fat, starch, or coloring mat- 
ter. The cachexia or diathesis has a modifying influence. 

(1.) Amyloid or Starchy Degeneration. — Waxy, lardaceus, 
or albuminous liver is a common termination of chronic inflam- 
mation in a tubucular patient, still it might co-exist with a fatty 
liver. The glandular structure is gradually converted into 
dense material ; first thickening from effused lymph, which 
chokes up the minute vessels, lobules, and hepatic cells, with 
abolition of their functions, and a usurpation by real vegetable 
starch, or starch-like matter. The change begins in the mus- 
cular fibre-cells of the middle coats of the small arteries, and 
the deposit continues till it takes the place of the lymph effused, 
and invades the proper structure of the organ, rendering it 
incapable of performing its proper function. After death the 
liver is increased in weight if not in size, from three or four 
pounds to eight or nine pounds, or more ; substance firm and 
glistening, or cutting it it resembles yellow wax ; cut surface 
often presents starch granules; all traces of lobules obliterated; 
iodine or sulphuric acid stain it blue or black. The predisposing 



400 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

cause is the tubucular or syphilitic cachexia; if this condition 
does not exist it can be acquired, the former by irritation in the 
body, as caries, chronic disease, fevers, the latter by contact in 
some way; chronic irritation of liver exciting cause. 

Synrotoms. — Starchy degeneration of liver does not exist 
without the same condition in spleen and kidneys, consequently,' 
the patient assumes acachectic, broken-down appearance ; loses 
strength and flesh rapidly, and is anaemic. The enlarged liver 
is usually almost as hard as a brick. Symptoms of chronic in- 
flammation may or may not exist, usually do, however, to some 
extent. There is a sense of weight and fullness in right side ; 
spleen enlarged and hard ; loss of appetite, indigestion, nausea, 
or loathing, flatulence, occasional attacks of diarrhoea, with pale 
stools. With the anaemia there is a peculiar sallow pallor ; albu- 
men in the urine ; very rarely any acute pain. Jaundice may 
be light or quite heavy ; ascites and dropsy of lower extremities. 
The disease, with much care, may be retarded, but, as a rule, 
it progresses on to a fatal termination. 

If it exists alone, without tubercle, syphilis or some disease 
of bones, or pulmonary phthisis, it may be considered more 
hopeful. For treatment, see Chronic Inflammation and Fatty 
Liver. 

(2.) Fatty Degeneration. — This condition of the liver usu- 
ally follows chronic inflammation from the use of whisky or 
beer, although it is found as a sequel from malarial poisoning, 
as in yellow fever and syphilis. 

It must be clearly understood that in speaking of fatty met- 
amorphosis, that there is no connection between the tendency 
to form fat around an organ, or the production of obesity and 
the change or usurpation of the normal tissue of an organ into 
fat. Obesity, if within proper limits, may be preservative; 
whereas the usurption of the tissue of a gland by fat is to be 
recognized as a process of decay or death from a defect in 
nutritive function. The cause of this retrogression is disease, 
old age, inactivity, and, above all, alcohol, which retards, 
degrades normal metamorphosis, blights tissue-forming, and 
aids directly in this fatty change. In whisky or beer-drinking 
there is besides a great quantity of oil naturally retained in 
the hepatic cells ; so that on a close examination, the latter are 
found gorged with oil globules, diminishing the normal gran- 
ular matter, and quite obscuring the nucleated nuclei. Liver 
is large, pale, smooth, greasy — often burning like fat ; heart, 
lungs, brain, kidneys, uterus, muscles, arteries, as well as liver, 
may suffer from it. Atheroma of arterial walls, and the arcus 
senilis of the cornea, is simply fatty degeneration. It may in 
rare cases be found in phthisis, but if proper search be made, 
fatty liver is the true evidence of whisky-drinking, with high 
living and lethargy. 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 401 

Symptoms. — All the leading features of chronic inflamma- 
tion of liver are present, together with a sense of weight or 
oppression about the liver, with marked anaemia and prostra- 
tion. There is usually gastric catarrh, dyspepsia, constipation, 
alternating with diarrhoea, pasty-looking complexion haemor- 
rhoids ; usually enlargement, ascites, swelling of extremities, 
acholia, or fatal prostration. 

Treatment. — The diet to be most nutritious ; an avoidance 
of fat, sugar, starch, whisky ; bowels to be regulated ; skin 
stimulated by daily bathing and flannel clothing ; irritating 
plaster to be worn over liver ; moderate but gentle exercise ; a 
persistent course of alteratives and tonics, and same remedies 
as for chronic inflammation of liver. 

(3.) Pigment Liver. — After death in yellow fever, malig- 
nant, bilious, intermittent and remittent fever, the liver is often 
found to be of a black or chocolate color, due to a pigment in 
the vascular structure of the gland. The loading of black or 
melanotic matter in the capillaries of the liver tends to their 
destruction and wasting of the liver. There is usually gastric 
catarrh, diarrhoea, cerebral irritation, and ascites. 

So far, it is not amenable to any treatment. 

ATROPHY OF THE LIVER. 

In chronic inflammation, with effusion of lymph, the ten- 
dency is to enlargement of the liver ; still, when amyloid and 
fatty degeneration follows, it is no unusual thing for the liver 
to shrink and become small, but it remains hard. These belong 
to liver degeneration proper, but there are two varieties of 
atrophy that take place without the elements of fatty or starchy 
degeneration. Thus, for example, we have often cases of 

(1.) Acute Atrophy of Liver, or, as some term it, yellow, 
acute, wasting of liver, or softening and breaking down of that 
gland. It is one of the most remarkable and fatal affections 
of the liver, and consists in a complete destruction of the hep- 
atic cells through the entire gland. 

Causes. — Those are alleged to be nervous depression, as 
grief and anxiety, fright, passion, venereal excesses, syphilis, 
excessive whisky-drinking in an habitual drunkard, or other- 
wise, the germs of malaria and bacteria, poisons of mercury 
and phosphorus 

Symptoms. — Preliminary Stage: May last some weeks or 
months, and is characterized by general depression, headache, 
loss of appetite, thirst, drowsiness, violent palpitation of heart, 
mental and physical prostration, irregularity of bowels, tender- 
ness of abdomen, some bloating; tongue may be clean, but 
conjunctiva becomes tinged with bile, and skin slightly jaun- 
diced, after a while. 

38 



402 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

Confirmed Stage. — This sets in and resembles yellow fever ; 
there is jaundice, with petechia and large ecchymosis, or purple 
patches; nausea, vomiting, first of slimy products; then of 
matter like coffee grounds, which is blood altered by the acids 
of the stomach. The tongue now, as well as teeth and gunls, 
is coated with black sordes ; there is great irritability, pro- 
found despondency; soon followed by wandering or low-mut- 
tering delirium ; convulsions, stupor and deep coma ; pain is 
often quite severe over both stomach and liver ; the area of 
dullness is so greatly diminished, that the liver can be scarcely 
felt; obstinate constipation; purgatives bring away hard, clay- 
colored stools ; later the passages are black from containing 
blood ; difficult micturition ; urine loaded with bile pigment 
and albumen; increase of jaundice; haemorrhages from nose; 
stomach, bowels, bronchi ; usually bed sores. Its duration in 
this stage is seldom over a week. 

Treatment is of no utility. Try same treatment as for acute 
inflammation of liver, with large doses of quinine and mineral 
acids. 

(2.) Chronic Atrophy of Liver has no connection or resem- 
blance to acute atrophy, but seems to depend on inflammation 
of a low grade, with obstruction and arrest of capillary circu- 
lation and defective nutrition. 

Symptoms likely to come on slowly and insidiously, taking 
years to develop, exhibiting, first, chronic inflammation of liver ; 
then shows a shrinkage; digestion becomes more imperfect; 
flatulence, constipation, alternating with diarrhoea; pale, clay- 
colored stools ; very dry and sallow skin ; loss of flesh and 
strength, with anaemia and persistent wasting ; general dropsy 
and exhaustion. 

Treatment same as chronic inflammation of liver, with very 
nourishing food, warm clothing; guard against over-fatigue, 
and depend on general vegetable alteratives and tonics. 

HYPERTROPHY OF LIVER. 

There are a variety of forms of enlarged liver ; it may be 
increased in size and weight in chronic inflammation, with 
effusion of lymph in fatty or starchy degeneration, and from 
the presence of tumors, but those are not conditions of true 
enlargement. 

Hyperthrophy of the liver proper is characterized by an 
increase in the size as well as the number of the secreting cells, 
causing general enlargement of the gland. It is usually the 
result of long-continued congestion, such as takes place in all 
tropical climates from the irritation of malaria and whisky. 
It may be looked for in indurated spleen, or leucocythaemia, in 
or after dysentery, and very common in the glucose diathesis, or 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 403 

diabetes. It is often met with in a lobe or portion of the liver. 
It is then said to be partial. It is brought about by the healthy 
portion having to do the work of a portion diseased ; its cells 
become enlarged, new ones are developed, and in this way the 
developed part compensates for that which is diseased. It 
gives rise to gastric catarrh, etc. Treatment same as for chronic 
inflammation. 

TUMORS IN LIVER. 

Besides the usurpation of the proper structure of the liver b} r 
fat, starch, and excessive interstitial development, the gland is 
liable to be the seat of new formations, mostly originating in 
the substance of the liver. 

The following may be enumerated as a few of these growths : 

(1.) Cystic Tumors. — Encysted, knotty tumors, containing a 
cheese-like substance are found in the glandular substance, 
varying in size from a pea to that of a hen's egg They arise 
from irritation and inflammation of the hepatic ducts ; steato- 
matous contents composed of irregular granules, free oil glo- 
bules, and occasionally plates of cholesterine. 

Simple Serous Cysts, with clear watery contents, are some- 
times found scattered over the liver, usually about the size of 
a small bean. 

Sacculated Cysts, containing a glairy fluid, are also met with. 
In some cases they resemble a honey-comb. The liver in some 
cases is crowded with such cavities. 

(2.) Calcareous Deposits. — In nervous dyspepsia, stone in 
bladder, etc., or rather in the alkaline diathesis, we often meet 
with deposits of phosphate of lime, varying in size from a grain 
of barley to a large goose egg. They grow by aggregation of 
molecules, and, when lajge, give rise to abscess. In some rare 
cases they become encysted. 

(3.) Cavernous Tumors are commonly found in the upper 
portion of the liver of aged persons. They are developed in 
the hyperthrophied connective tissue. On the surface they look 
like dark blue colored spaces ; vary in size from a pea to a 
large egg. On cutting into them, they are found to be filled 
with dark blood. 

(4). Tubercular Deposits are found in the liver; sometimes 
a few; in other cases a great number. The deposit takes place, 
and tubercle grows, but not to large size. It is found albu- 
minous, cheesy and calcareous. In some cases it is associated 
with fatty deposits. 

(5.) Hydatid Tumors occur in the liver more frequently 
than in any other gland, although we meet with them more 
rarely in the spleen, omentum, muscles of the heart, brain, 
kidneys, lungs, ovaries, and bones. 



404 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

A hydatid tumor consists of a sac formed by a condensation 
of surrounding tissue, lined by a bladder or cyst, which is 
filled with a limpid salt fluid, floating in which are found 
numerous small bladders, which contain the entozoa, known 
as the echinococcus. The echinococcus are the larva, the scolice, 
or embryo, or immature tape-worm of tsenia echinococcus, 
which infests the dog. 

Symptoms. — As hydatid tumors grow very slow, and give 
rise to little irritation or inconvenience beyond a sense of 
weight and symptoms of chronic inflammation of the liver, 
when the volume of the liver is greatly increased and the tu- 
mors large, they can often be detected either by a sense of fluc- 
tuation, or by a peculiar vibratory thrill or sensation called the 
hydatid fremitus. If the cyst inflame there may be violent 
pains, active symptoms of inflammation of the liver, with ascites 
and oedema of legs. Its duration may extend over a period 
of many years, and either one or other of the following events 
may take place : In favorable cases the fluid in the cyst may 
be absorbed, walls of cyst contract or collapse, no rupture take 
place, and its seat be filled, or thick, putty-like substance, and 
perfect recovery. Another very favorable termination, but not 
so good as the former, is for adhesions to form between perito- 
neal coat of liver and walls of abdomen, or peritoneal coat of 
bowel, and the tumors to burst, either externally or into the 
bowel. In other cases it may burst into hepatic duct, whence 
contents may pass into duodenum. The most unfavorable con- 
dition is for the cyst to burst into the abdomen, causing fatal 
peritonitis and death. 

Treatment. — As soon as a hepatic tumor is made out, the 
general treatment for chronic inflammation of the liver should 
be very rigidly carried out ; vegetable alteratives and tonics, 
embracing iodide of potass, or ozonized glycerine and ozone- 
water as special remedies. The ozonized clay should be kept 
applied over region of the liver ; if it causes redness poultice 
till it disappears, and then re-apply the clay. The clay has a 
marked, decided action in amyloid, fatty degeneration, and all 
tumors of the liver; its use forms a new era of most successful 
treatment; it has a wonderful efficacy in renovating this im- 
portant gland, and its efficacy in large hydatids is astonishing 
indeed; it has superseded electrolysis; removal by aspirator; 
injections; tapping, and other dangerous remedies. 

CANCER OF THE LIVER. 

Usually, either medullary or scirrhus, easily recognized by 
the cachexia, the pain, anterior, and posterior, and other indi- 
cations of malignant disease ; besides all the symptoms of 
chronic inflammation, enlargement of the liver, loss of form, 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 405 

uneven, bulging prominences ; nodular mass gives rise to perito- 
nitis. The daily loss of flesh and strength is appreciable ; dys- 
pepsia, great mental prostration, jaundice, ascites ; often forma- 
tion of gall-stones. 

Its duration is short. 

Same treatment as for cancer, with steady application of 
ozonized clay over region of the liver. 

GALL-STONES. 

Biliary calculi are generally found in the gall-bladder, more 
rarely in the liver, and in branches of hepatic duct. 

The principal ingredients of gall-stones are cholesterin, 
cholochrome, or coloring matter; earthy and alkaline salts, 
such as phosphate and carbonate of lime and magnesia, together 
with biliary and fatty acids. They are found large and small, 
solitary and multitudinous. Solitary calculi, when found in 
the gall-bladder, are globular, or oval, or pear-shaped ; asso- 
ciated stones usually have numerous polished facets, the result 
of pressure and mutual attrition. Gall-stones found in the hepatic 
duct, or its branches, are small, rough, or tuberculated, and of 
a very dark color. Gritty, sand-like deposits are met with in 
the excretory passages of the liver, consisting of minute calculi, 
or of a powder formed of cholesterine and colochrome, biliary 
gravel. 

Causes. — Anything that interferes with or retards the func- 
tional activity of liver, as solar heat, malaria, alcohol, tobacco ; 
or prevents a due decarbonization of blood by lungs and skin, 
as sedentary habits, tight lacing, want of exercise, isolation, 
sameness of life and diet, or monotony, or any morbid con- 
dition of the liver ; anything that can be imagined that will 
cause a coagulation or crystallization of the chemical elements 
of the bile. 

Symptoms. — Are very variable, depending upon the loca- 
tion of the stone, and its size. In branches of the hepatic duct 
small calculi may give rise to dull pains about the liver, shoot- 
ing to the shoulder ; to symptoms of intermittent fever ; gastric 
disturbance, with nausea. As they usually only cause tempo- 
rary obstruction to a free flow of bile, there is no jaundice. 

The hepatic duct is rarely blocked up with a concretion ; if it 
is, it will give rise to intermittent pains, attacks of vomiting, 
jaundice, enlargement of liver, owing to the escape of bile from 
all the ducts being prevented. Danger of rupture of dact-stones 
may be present in the gall-bladder without producing any 
morbid derangement, for they rarely set up catarrhal or plastic 
inflammation ; still there is likely to exist copper taste in mouth, 
fetor of breath, brown coat on tongue, yellow tinge of the 
white of the eye; pain in back of head, and over the region of 



406 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

liver, right shoulder and hip ; loss of appetite; indigestion, con- 
stipation. 

If a calculi of any size leave the gall-bladder and enter the 
cystic duct, then we have well-marked symptoms. A sudden 
seizure of intense, excruciating pain in the region of the gall- 
bladder, which moves along a tract, followed by nausea and 
vomiting; less or more pain over the entire liver and shoulder; 
pain over gall-bladder is not constant, comes and goes ; rigors, 
prostration, with feeble pulse and clammy skin ; nausea and 
vomiting become aggravated ; paroxysms become so severe that 
patient bends herself double, pressing hands firmly against the 
pit of the stomach ; one paroxysm following another, when, all 
on a sudden, the stone drops into the duodenum ; there is instant 
relief; constipation. If the stone is large enough to fill the 
duct, jaundice must take place ; the gall-bladder becomes greatly 
distended, and liver progressively enlarges, and ultimately 
death may take place from perforation. Still nature is won- 
derfully provident of herself, and the stone or stones are more 
likely to ulcerate their way into the bowels, or through the 
abdominal walls. 

Treatment. — If patient is seen during the passage of the 
stone, the patient suffering attacks of excruciating pain, his or 
her suffering must, if possible, be relieved. Tincture of green 
root gelseminum, with opium, should first be tried, with either a 
hot bath, or hot fomentations, over liver and abdomen. If that 
is not successful, let the patient inhale a very small amount of 
chloroform, and just when it is about to act, introduce a sub- 
cutaneous injection of morphia, and discontinue the chloro- 
form ; then keep on with hot fomentations and gelseminum to 
relax the duct ; and if the stomach will tolerate it, give large 
doses of olive oil ; if it is rejected, use copious draughts of hot 
water, with bicarbonate of potassa. As soon as stone is passed, 
there is relief. Then the point to be aimed at is to dossolve 
others that may be in the gall-bladder, and prevent new forma- 
tions. For this purpose, change of diet, habits, exercise, alka- 
line bathing, should be recommended, and all causes removed. 
Ozonized clay over liver is invaluable. A selection of some of 
the following remedies should be tried, to prevent the forma- 
mation, and cause the disintegration of such calculi : 

Nitromuriatic Acid : Not only a liver stimulant, but excellent 
solvent. Administer in compound tincture cinchona, in six- 
drop doses, thrice daily. 

Phosphate of Soda prevents formations, and has disintegrating 
properties. In this respect, any alkali, as preparations of soda, 
potassa, ammonia, are of utility. 

Olive Oil seems to possess powers of dissolution, besides aid- 
ing their easy passage. 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 407 

Ozone-water, sulphur-water, iodine-water, rank next to nitro- 
muriatic acid. Podophyllum, leptandra, chionanthus, nux vom- 
ica, taraxacum, are of little utility, unless combined with bitar- 
trate of soda, or nitrate of potassa; then they are very efficacious, 
as four grains of nitre of potassa, to half a teaspoonful of cream 
of tartar, in an infusion of either dandelion or wahoo. 

Friction, shampooing, manipulation of all kinds, very hurtful, 
and neither aid in the non-formation of stones, nor in their 
expulsion. 

The entire regime of the patient should be altered : daily 
bathing; keeping bowels open; a non-carbonaceous diet; no 
sugar, fat, alcohol, or beer; exercise in open air, and change. 
Inculcate strongly into the patient, that in order to enjoy the 
highest degree of health, that change in all things is indispen- 
sable — nothing so deteriorating to the vital integrity of man as 
monotony, sameness, isolation. To ladies, gall-stones are an 
especial scourge, which is not to be attributed to their monot- 
onous life so much as to tight-lacing, which strangulates the 
'liver, displaces the gland, and is sadly productive of gall-stones; 
let her remove the cause. 

JAUNDICE. 

This is always to be regarded as a symptom of disease of the 
liver, never a morbid condition of its own. It may, therefore, 
be regarded as a symptom of congestion, inflammation, irrita- 
tion from poisons, degeneration, tumors, gall-stones or acute 
or chronic atrophy, yellow fever and mental excitement. All 
forms of jaundice may therefore be classed under two heads : 
(1.) Those in which the functions of the liver are suppressed or 
won't w r ork, and the coloring matter of bile and cholesterine 
accumulates in the blood. (2.) When the liver works, perhaps 
well, bile is secreted in abundance,but cannot get away; there 
is an obstruction to its exit in the duodenum by gall-stones, 
or by pressure, or something, and the bile is re-absorbed into 
the blood. This condition cannot last very long without the 
liver ceasing to work, for the bile, being dammed back on the 
gland, becomes a poison to its own structure. If due to dis- 
ease of liver, there will be oppression, pain, over liver ; if due to 
gall-stones, there will be the nausea and paroxysms of severe 
pains. 

Symptoms. — Jaundice, then, a symptom of liver disorder, 
disease or depression, is characterized by yellowness of skin 
and conjunctiva, nausea, loathing of food, especially fatty sub- 
stances, tongue coated brown, usually constipation ; stools, if 
any, pale or clay, or white colored ; urine very scanty, and 
of a saffron color, or dark mahogany color, according to the 
amount of bile pigment present. Drowsiness, giddiness and 



408 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

peevishness, dyspepsia, bitter or copper taste in mouth, slow 
pulse, weakness or exhaustion ; itching in the skin. In very 
severe cases the aqueous and vitreous humor of the eye is so 
heavily tinged with bile that the patient sees everything yellow ; 
very drowsy. 

If it is severe and allowed to last long there may be stupor, 
delirium, and great cerebral disturbance ; extreme weakness 
from mal-nutrition ; there may be haemorrhage into the skin, 
profuse bleeding from nose, gums, stomach or bowels. 

The Treatment, in all cases, will consist in a gentle emetic 
of mustard and salt, opening the bowels with salines, as the 
mixture of salts; daily baths; diet to consist of milk, raw 
eggs, white-fish boiled, or oat-meal, and an abundance of ripe 
or cooked fruit ; the ozonized clay over liver steady ; then 
select two of the following, and administer alternately at inter- 
vals apart, highly diluted in water. 

Nitromuriatic acid, in bark ; phosphate of soda in some 
drink ; sulphur, in any form, is indispensable ; and any of the 
vegetable chologagues, as podophyllum, leptandra, euonymus, 
chionanthus, kurchicine. 

Whichever is selected must be given with either cream of tartar 
or nitrate of potassa. If there is any syphilitic taint, iodide of 
potass is indispensable. 

In order to test the patient's urine for bile, pour a small 
quantity out in a stoneware plate, then add chemically pure 
nitric acid, drop by drop ; there may be at first a play of colors — 
green, blue, red, or sometimes only greenish — which alone 
shows or indicates bile pigment. 

ACHOLIA. 

A perfect arrest of the functions of the liver, so that matters 
from which bile is formed accumulate in the blood, producing 
toxaemia. 

Acholia may take place during the progress of almost any 
disease of the liver, but almost an invariable attendant in 
acute atrophy. A very remarkable disease, in which there is 
a destruction of the hepatic cells, and rapid wasting of the 
gland. 

Acute atrophy of the liver evidently depends on impaired 
nutrition, and may be caused by great mental and physical 
prostration, venereal excesses, use of mercury, whisky, malaria. 
Still, no very satisfactory reason can be assigned why those 
agents should cause one-third, or one-half, or two-thirds of the 
liver to waste and disappear in a few days — a gland so very 
rich in blood — and without any change in the bloodvessels 
themselves. No other disease bears any analogy to it. 

In chronic alcoholism, where it is most common, we can 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 409 

see a poison that acts directly upon the hepatic cells ; the others 
are difficult to trace. 

Next to alcohol, the action of the germs of syphilis and 
cancer have a tendency to destroy the glandular epithelium, 
and thus lead to an arrest of function. More rarely is acholia 
due to chronic inflammation, fatty and starchy degeneration, 
producing an impermeable state of the ductus communis, 
choledochus of the hepatic duct, to an arrest of capillary cir- 
culation. 

An effort at treatment must be made — the ozonized clay 
applied over liver; the use of the various remedies already 
recommended in chronic inflammation. 

DIABETES, MELITUS. 

Mellituria, or grape sugar in the blood, or, as it is often 
termed, saccharine diabetes, is a complicated chronic disease, 
characterized by the presence of glucose or grape sugar in the 
blood and fluids of the body. It seems either to originate in 
the brain, at the origin of the eighth pair, in the floor of the 
fourth ventricle, between the auditory and pneumogastric 
nerve, or in the peripheiy of those nerves in the stomach, 
pancreas and liver. If we prick the mesial line in the floor 
of the fourth ventricle, in the centre of the space between the 
origin of the auditory and pneumogastric nerves, we produce 
an exaggeration of the hepatic secretion, an excessive elabora- 
tion of sugar, and an augmentation in the quantity of urine, 
which is not only superabundant, but loaded with saccharine 
matter. Or, again, if the periphery is irritated in stomach, 
pancreas, liver, and the centre weakened to receive the irrita- 
tion, the same result follows. In this condition the portion of 
the visceral brain, great sympathetic, over stomach, liver, and 
lower lobe of right lung, is equally affected. The origin of 
the glucose diathesis, or melituria, is to be found in some en- 
feebled condition of the co-ordinating chemical centre, or in its 
periphery. 

Causes. — Shocks, falls, blows, concussions, overwork, strug- 
gle for existence, worry, mental anxiety, depressing passions, 
as grief; exposure to sun, or vicissitudes of climate ; disease of 
stomach, pancreas, liver, as gastric or duodenal catarrh, alcohol. 
Occasional attack?, due to drugs or inhalation of chloroform, 
whisky, are simply passive conditions. 

Symptoms. — Come on slowly and insidiously, with great 
muscular and nervous debility; immense amount of urine 
voided, of an apple odor, and usually of a high specific 
gravity of from 1035 to 1060. Still cases are often met with 
where it is lower; skin is very dry and harsh; obstinate con- 
stipation, gradual failure of strength and loss of sexual power ; 



410 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

pain in loins ; extreme prostration ; coldness of extremities, 
with sense of burning in hands and feet. Debility increases, 
weight diminishes, body shrinks, withers; oedema of feet; 
sometimes albuminuria ; breath has a chloroform odor from 
imperfect combustion of sugar ; gums spongy ; teeth drop out ; 
mental depression and irritability ; constant sense of sinking 
at pit of stomach ; appetite for food voracious ; thirst extreme ; 
strong tendency to cataract. After it has lasted months or 
years, the lower lobe of the right lung, which is so fully cov- 
ered by branches of the sympathetic, becomes literally invaded 
with tubercle, colonizing from below and proceeding upward. 
There may be boils. 

The above are the common symptoms, when it originates in 
the brain, the great co-ordinating chemical centre; but when 
it starts in gastric intestinal catarrh, from the presence of some 
poisonous substance or morbid material generated in the intes- 
tinal tract, there may be in the early stage localized or paroxys- 
mal pain in the upper part of the abdomen, and vomiting of 
green-colored matter, exceedingly obstinate constipation, heart 
affection, cerebral irritation, somnolence, great prostration, 
febrile spells, in which the pulse is frequent and small, with 
very rapid breathing, with remarkably deep inspirations, dry 
tongue, intense thirst, and no elevation of temperature. By- 
and-by the symptoms coalesce. 

The whole train of symptoms point to a nervous origin at 
the base of brain; even the eye-symptoms can be partially 
explained. The spinal root of the optic blending with the 
sympathetic and passing the origin of the eighth pair, in the 
base of the brain, may receive a pathological effect ; at all 
events, this root brings the retina into direct communion with 
the co-ordinating chemical centre and the medulla. The 
existence of this branch is interesting, as it throws light on the 
physiological relation between the parts affected in diabetes, 
the medulla and retina, and it constitutes the undiscovered 
link between certain diseases of the spinal cord and eye. 

Besides, the very common termination — tubercular consump- 
tion, bronchitis, pneumonia, peritonitis, gangrene — may take 
place, or the patient die from exhaustion. 

To constitute the morbid condition, there must be a persist- 
ency of sugar in the urine with the symptoms. This can be 
readily detected by the potash, copper, or fermentation tests. 

It is clearly to be understood that the liver, under this weak- 
ened or irritated nerve, can, will secrete, and continue to secrete, 
sugar, without either sugar or starch being introduced into the 
stomach. If sugar or starch is taken in, we then are feeding 
a poison the system cannot get away with. What becomes of 
the sugar that is taken in, in some cases, even in large quanti- 



DISEASES OF THE LIGER, PANCREAS, AND SPLEEN. 411 

ties, seeing none of it is ever found in the chyle or portal vein ? 
It must be transformed somewhere, and this transformation is, 
no doubt, effected in the duodenum by the agency of the pan- 
creatic juice. If the digestion of sugar does take place in that 
way, and it should happen that the pancreatic secretion was 
insufficient, from disease of the pancreas itself, from the dis- 
turbing and inhibitory influence upon the nerves controlling 
the secreting function of pathological events, or from the con- 
stant injesta of sugar in too large amount, a greater or less 
quantity of sugar which has escaped transformation must accu- 
mulate in the intestines. Of all tissues that keenly absorb 
sugar, the intestinal tract is the most active, especially the 
small intestines. 

Treatment. — In the general management of the case, daily 
bathing, flannel clothing, bowels to be opened daily; for great 
improvement follows the abundant evacuations of extremely 
offensive and almost black quantities of excremental matter ; 
so, as a rule, empty the bowels daily; for it is not too far-fetched 
an idea that the sugar has undergone decomposition in the 
intestines, and aids in producing that terrible burning and 
thirst so common in diabetes. 

The diet is to be highly nutritious, and free from sugar and 
amylaceous ingredients, for then the pancreatic juice is suffi- 
cient to meet the trifling amount of sugar present. How far 
the pancreatic juice suffices for the transformation of sugar in 
different cases, it is difficult to say. It is difficult to prepare a 
diet list entirely free from sugar, for even flesh, yolk of eggs 
and most acid wines contain sugar; and with regard to vegeta- 
bles, the stalks and ribs of salad and leafy herbs all contain 
sugar. In short, with the exception of cheese and sour milk, 
there is scarcely any edible to be found that does not contain 
sugar. If, in spite of a diet of flesh, white-fish, game, eggs, 
beef-tea, cream, cheese, bran-loaf, gluten bread, herbaceous veg- 
etables, the sugar does not disappear, we know that the case is 
beyond the reach of pancreatic influence, or the patient may 
not have adhered strictly to the rules. Rigidly forbid sugar, 
fruit, confectionery, potatoes, carrots, parsnips, beets, turnips, 
radishes, rice, sago, arrowroot, tapioca, liver, oysters, lobsters, 
crabs, beer, whisky, coffee. If able, gentle exercise in open air. 
Two small irritating plasters, an inch square, should be kept 
constantly applied at the nape of neck ; one on each side, and 
ozonized clay over region of liver. A persistent alterative 
and tonic course commenced and persevered with ; vegetable 
extracts, with iodine and such tonics as cinchona. The appe- 
tite for thirst or food is best removed by administering glycerite 
of ozone, or dilute phosphoric acid, or glycerite of kephaline ; 
follow or precede meals with pepsin. 



412 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

Now, after inculcating the above, our treatment is purely 
empirical, and confined chiefly to the use of some of the follow- 
ing remedies, the selection in the mind of the practitioner 
being, in some measure, due to the idea he may entertain as 
to the pathology of the disease. 

Salicylic Acid. — If in diabetes the co-ordinating chemical 
centre is only weakened to such an extent, that though glucose 
appears in the blood, aloxan is still formed, and appears in the 
liver, salicylic acid will combine with it, decompose the gly- 
cogen, and so prevent the formation of sugar; but if the centre 
be further weakened, then the salicylate can no longer decom- 
cose the glycogen, and the amount of sugar generated is unaf- 
fected by the remedy. So in an old case of diabetes, little benefit 
is derived from the use of the salicylic acid administered alone, 
but, combined with caffein, it is still worthy of a trial. It 
should be given in fair doses, so as to be powerful enough to 
enter into combination ; the antecedents of the glucose causes 
the entire disappearance of the sugar in the urine. Populin 
has the same affect. 

Antiseptics. — The blood in diabetes is very pink in color — 
serum milky, white cells abundant, and a large amount of fat 
granules, supposed to be caused by the sugar assuming the 
form of a fungus in the blood. Taking this view of the case, 
ozonized glycerine acts very efficaciously in destroying the fungus 
in the blood ; it very promptly arrests the appetite for thirst, 
brings urine down to normal standard, and patient rapidly 
improves. 

The resonoid of crude petroleum has also a similar effect. 
Permanganate of potassa, in one-half-grain doses thrice daily, 
operates like a charm. Balsam of copaiba, either alone or com- 
bined in the form of the golden tincture, reduces the sugar 
and specific gravity to a cipher ; chloride of calcium is essen- 
tially a remedy of great value. 

Again, if the practitioner views the case as an irritation of the 
visceral Drain, he will use opium, white hellebore and quinine 
often with the very best results — a grain of opium thrice daily. 

Nux vomica and poplar bark operate in all cases well. Ergot 
is of no utility, but useful in profuse diuresis to contract the 
arterio-capillary vessels, which are often relaxed in disorders 
of the vaso-moter system. 

DISEASE OF THE PANCREAS. 

It is rare to find disease of the immaculate pancreas; rare 
for us to breathe a word of suspicion against this organ, which 
plays such an important part in secondary digestion; it enjoys 
a remarkable immunity from disease. The reputation that 
the pancreas has acquired is well earned, for we can bring 



DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 413 

few accusations against it. To some extent, this may result from 
our inability to make out a morbid state. 

Disease does occur here at rare intervals, and in isolated cases, 
such as congestion, inflammation, hyperthrophy, induration, 
suppuration, and serous softening. There are also cases of 
atrophy, f-dtty, cystic or hydatid degeneration, as well as calca- 
reous or phosphatic concretions.* 

The principal points by which disease of this gland is recog- 
nized are debility and emaciation, with the presence of fat in 
the stools; loss of appetite; inodorous eructuations ; brown coat 
on tongue, with transverse fissures, nausea, vomiting, saliva- 
tion, mental depression; likely to be some enlargement and 
tenderness of the gland ; fullness or hardness, with a sense of 
constriction. 

Treatment involves general principles: bathing, diet, same 
as in diabetes ; ozonized clay over region of stomach ; about an 
hour after meals, pancreatine. General alteratives and tonics. 
There are some drugs that act specially on the pancreas, as 
sulphuric ether, blue flag, ozone-water. 

THE SPLEEN. 

The spleen is a most important organ, a ductless gland, a 
perfect store-house of red blood, and possesses a function of 
holding a large volume of blood when driven in by a chill, 
and of being a propeller of blood. In this sense it is its own 
heart, but it is difficult to appreciate this function in its rela- 
tion to the splenic circulation only. The splenic blood enters 
the vessels of the liver, and with such force the blood is expelled 
from that organ much accelerated. The spleen may be regarded 
as a liver-heart, aiding in its degree — small it may be, yet 
definite — the difficult movement of the blood through the second 
series of vessels it has to traverse before it again attains the 
general circulation. The contractions of the spleen accelerates 
the movement of the blood corpuscles, between its own inter- 
stices and the blood, and thus aids the changes which the blood 
undergoes when passing through the organ, and affords an 
explanation for the white cell blood-disease, so common when 
this gland is blocked up or enlarged. 

Disease of the Spleen. — The spleen, like all other glands, 
is liable to congestion, acute and chronic inflammation, soften- 
ing, abscess, gangrene, tubercular, amyloid, and malignant dis- 
ease; fibrous deposits, serous and hydatid cysts, simple enlarge- 
ment, and enlargement with leucocythsemia. 

Enlargement of the spleen, from the presence of the malarial 
germ in the blood, is very common in tropical climates. It 
may be a result of acute inflammation, as in yellow fever, or 



414 DISEASES OF THE LIVER, PANCREAS, AND SPLEEN. 

of chronic irritation in intermittent ; besides, the malarial germ 
has a tendency to cause embolism of the blood. 

This hypertrophy of the spleen almost invariably gives rise 
to white cell disease of the blood. In what manner this store- 
house of red blood effects this wonderful change in the blood, 
it is difficult to say. 

The symptoms of ague-cake, or indurated spleen, are general 
debility and loss of flesh. The skin has a peculiar sallow, anae- 
mic appearance; general anaemia; albumen in urine; tendency 
to haemorrhage, with the spleen hard and large. 

Treatment. — Good, nourishing food, daily bathing, flannel 
clothing. If there are still indications of the activity of the 
malarial germ, same treatment as for intermittent fever. The 
special treatment to get rid of the enlargement is alteratives 
and tonics, with ozonized clay kept pretty constantly applied 
over spleen; never causing redness. This remedy operates like 
a charm. 

The iodide of potassium, so long in use, is superseded by the 
more active remedy, glycerite of ozone. By the use of the clay 
locally, and the ozone internally, few cases of enlarged spleen 
fail to make a good recovery in a few months. Besides, there 
are other drugs that can be used by way of a change, such as 
the bearsfoot, which has an excellent action internally in the 
form of fluid extract, beginning with five-drop doses, and 
increasing every three hours. An ointment made of the bears- 
foot, rubbed in or applied, is also beneficial. 

If, under this treatment, the enlarged spleen does not yield, 
we must inculcate a more rigid course of treatment. We must 
bear in mind that in this enlargement or embolism of the 
spleen, there are deposited fatty granules, intermixed with pig- 
ment or coloring matter; that all through its friable interstices 
there are millions of bacteria, ever acting on the red blood 
discs, impairing their embryonic vitality. 

This fact, the presence of micro-organisms in the spleen, 
impairing the elementary molecules, giving us the persistent 
white cell blood, imperatively calls for antiseptic treatment, as 
the ozonized extracts of saxifraga and phytolacca, while any 
good bitter tonic that promotes an appetite and stimulates the 
liver will be of service. 

The ozone water, also, is of great utility, as it enters the 
circulation undecomposed, and, coming in contact with the 
germ, annihilates it. 



DISEASES OF THE ABDOMEN. 415 



DISEASES OF THE ABDOMEN. 



VOMITING AND RETCHING. 

Vomiting is due to forcible and repeated contraction of ab- 
dominal muscles, the diaphragm being pressed by closure of the 
glottis ; the stomach is thus compressed against the diaphragm, 
and by this force, together with its own contraction, the pylo- 
rus being closed, and the cardiac sphincter relaxed, the gastric 
contents are expelled upwards. In retching there are fruitless 
attempts to empty the stomach, the cardiac sphincter being 
contracted, or the stomach empty. 

Nausea, vomiting, and retching, are present as symptoms in 
many diseases, as in cerebral, spinal, pulmonary, biliary, gas- 
tric pancreatic, intestinal, uterine, ovarian disorders. They are 
often reflex, as in pregnancy, irritation of pneumo-gastric nerve, 
as in poisons and irritating substances. To disease-germs in 
blood, as small-pox, scarlatina, yellow fever, ichorsemia, etc. 
To acute or chronic gastritis or peritonitis. To abdominal 
aneurisms, tumors, ascites, to invagination of bowels, strangu- 
lated hernia, or some latent, morbid state. 

When the vomiting is due to some derangement of stomach, liver, 
and intestines, it is likely to be preceded by nausea, discharge of 
contents of stomach, biliary matters, offensive secretions, acid 
matter, pus, blood ; tongue usually coated, breath foul, white of 
eye tinged, abdominal griping pain, fetid, eructations, diarrhoea, 
unhealthy stools, and the headache is frontal. 

When due to some brain difficulty or reflex condition acting on a 
iveakened bulb, there is no nausea, no food, tongue clean, breath 
sweet or pure, and if there is headache, is mostly behind ; no 
belching of foul gases. 

If vomiting and retching is due to disordered stomach, liver, pan- 
creas, bowels. 

Lobelia emetic, cleanse out bowels, saline purge, or compound 
licorice powder, and follow with cinchona and nitromuriatic 
acid ; a bland, simple diet, rest. 

If due to diseased germs in fevers, give antiseptics, as ozone- 
water, carbolic acid, and tincture of iodine, yeast and milk. 

If due to inflammation, as in acute gastritis, peritonitis, yellow 
fever,green root tincture gelsemium and morphia, mustard over 



416 DISEASES OF THE ABDOMEN. 

stomach, toast-water in half teaspoonful dose, lime-water and 
milk, ice in mouth, but spit out fluid as it melts. 

If due to cholera germs, ozone-water, camphor, menthol, car- 
bolic acid and iodine, with external warmth. 

If due to alcohol, aromatic spirits of ammonia, with infusion 
of columbo, or kurchicine. 

If due to reflex irritation, in pregnancy, try strong cup of 
coffee before getting out of bed in the morning; oxalate of 
cerium in five-grain doses thrice daily; infusion of cloves, 
lemon juice. Drop doses of wine of ipecac, laurel water, sul- 
phurous acid, spirits of chloroform. 

1/ due to hysteria, musk-root, valerian shower baths, cups to 
loins. If it does not yield, uterine alteratives ; food and liquids 
in small quantity. 

Sea-sickness. — A flannel roller around abdomen ; a few drops 
of chloroform in sweetened water ; inhalation of from five to 
eight drops of nitrite of amyl. A one per cent, solution of nitro- 
glycerine in minim doses, repeated ; bromohydric acid, carbonic 
acid gas, as in champagne, effervescing salt ; recumbent posture, 
head to bow of ship. 

In some cases a cup of tea and soda biscuit, early rising, keep- 
ing centre of vessel, and avoid wine, alcohol. 

HICCOUGH. 

Hiccup is a short, convulsive, and noisy inspiration, followed 
immediately by expiration. It is due to the sudden and invol- 
untary and momentary contraction of the diaphragm with the 
simultaneous narrowing of the glottis. 

The cause is either in the brain, at the origin of the pneumo- 
gastric and vagus, or at their periphery in the stomach or re- 
current branches in the diaphragm. Occurring in brain irri- 
tation or disease, it is to be looked upon as one of great danger 
when dependent on irritation of digestive organs ; usually not 
to be dreaded, but the paroxysms occurring at short intervals, 
and for days in succession, give rise to pain about the heart, 
and great exhaustion. Young and old are most liable to at- 
tacks. In all cases the treatment should be adapted to the 
cause ; but if no acute or dangerous malady is under way, in a 
mild case, it can be checked by patient taking: a deep inspira- 
tion, and then holding the breath as long as possible, so as to 
keep diaphragm contracted. The wearing of a belt around 
epigastrium. In other cases it can be checked by snuffs, a good 
sneeze. 

In more severe forms. — Try one of the following remedies by 
the smell, as inhalation of a few drops of chloroform, ether, 
nitrite of amyl ; by the mouth, ammonia, musk, camphor, men- 
thol, Indian hemp, aconite, belladonna, nux vomica, chloro- 



DISEASES OF THE ABDOMEN. 417 

form, bromohydric acid, hydrocyanic acid; local, dry cups, 
aconite, belladonna and chloroform; liniment to nape of neck, 
and over diaphragm. 

If due to dyspepsia, emetics, bitter tonics, cinchona and am- 
monia. 

If hysterical, sumbul, valerianate of zinc. 

If intermittent, iodine and quinine. 

If infantile, a few drops of oil of aniseed, winter-green, warm 
bath ; see to the milk. 

OBESITY OR CORPULENCY. 

The over-accumulation of fat under the integuments and 
around the viscera constitutes obesity. Although it is essen- 
tially a non-vital condition, it is not to be confounded with 
fatty degeneration. 

Causes. — Hereditary tendency, with over-feeding, consump- 
tion of large quantities of fluid ; indolence, and too much 
sleep ; excessive use of fatty, farinaceous, vegetable and sac- 
charine foods, malt liquors, no care or anxiety. Fat is formed 
in the body from food containing it, also from the chemical 
transformation of starch and sugar. 

Symptoms. — Besides the increase of weight and bulk, there 
is an impeded play of various important organs, as lungs and 
heart; diminution of bodily and mental activity; disturbance 
of organs of respiration, circulation, and digestion; panting on 
the slightest exertion; blood is poor in fibrin, deficient in quan- 
tity as well as quality ; weakness of muscles, countenance bloated 
and sallow; liability to gouty and neuralgic affections. Obesity 
not condusive to longevity ; sudden death not uncommon. Par- 
tial obesity, such as fatty tumors, fat around heart in beer 
drinkers; fatty omentum or fat belly, in gormandizers. 

Treatment. — Bowels to be kept open twice a day ; bathing 
daily in alkaline or acid water ; sleep to be restricted to six or 
seven hours; patient to walk first a mile, then two, or more, daily, 
until he is lathered over with free perspiration, then stripped in 
a warm room and rubbed down briskly with aqua ammonia and 
water, and dry cloihes put on. This should be done before 
breakfast. If circumstances favor, horseback exercise. Diet 
should consist of meat, white-fish, green vegetables, biscuit or 
dry toast, tea without sugar; avoid or prohibit as much as pos- 
sible bread, butter, milk, sugar, beets, potatoes, beans, peas, and 
broths with coffee. Appetite improved if faulty, with bitter 
tonics, as gentian, quassia. 

Our best remedies to get rid of fat, are fucus vesiculosus, 
liquor potassa, iodide and bromide of potass. 

Fucus Vesiculosus, in fluid extract, in doses ranging from one 

39 



418 DISEASES OF THE ABDOMEN. 

to two teaspoonfuls thrice daily in water, regulating the dose 
so the patient will lose only one pound per week. 

Liquor potass, in doses of from ten to thirty drops, as above, 
in water. 

If iodide potass is tried, give it with same quantity of bicar- 
bonate, in infusion of sassafras. 

SEA-SICKNESS. 

Or motion sickness, as it may be termed, for it occurs on lakes, 
rivers, or other turbulent motions, and by riding backwards is 
a disturbance of a special sense, whose function is to determine 
the position of the head of man in space, and to govern and 
direct the mechanism by which the body is maintained in the 
erect posture and in equilibrium. This special sense is highly 
developed in the highly civilized Caucasian, and is his peculiar 
prerogative ; by it the grandeur of the Heavens, the beauties of 
nature, are realized; by it, man's mind is endowed with divine 
energy, and he can better appreciate his divine origin. This 
faculty of equilibrium is connected or seated in the brain, the 
optic lobes, the nervo-vital fluid or bed-plate of cerebrum and 
cerebellum, and other parts of the nervous organism, but its 
principal seat is in the semi-circular canals of the internal ear, 
which may be called the sense of equilibrium. 

Motion produces sickness by disturbing the endo-lymph in 
those semi-circular canals, the viscera of the abdomen, the bed- 
plate of brain, or the nervo-vital fluid upon which the brain rests. 
The motion may be either backward, forward, downward or 
oscillating, and should be continued for a certain length of time. 
A combination of these conditions is the most effective, espe- 
cially if there be an element of irregularity or uncertainty. 

There are three varieties or forms of sea-sickness, which can 
be clearly distinguished from each other, and each of which 
is susceptible of relief by appropriate treatment. Nausea and 
vomiting is a prominent feature of all the forms. They may 
be classed as follows : 

(1.) The Endo-lymph, flowing freely in the semi-circular canals 
of the inner ear, is subject to all the laws of fluids, inertia, 
gravitation, friction. It flows in a straight horizontal current, 
follows the motion of head and ship. The plane of the canals 
corresponds most nearly to the direction of the motion, face 
forwards; reverse the motion, and the endo-lymph continues 
to flow on, until it is arrested by friction, this causes undue 
pressure in one or more of the ampullae which causes a wrong 
impression to be carried to the sensorium, and insubordination 
and giddiness is the result — the fluid in the canals is agitated, 
rocked or washed about, the finer nerve filaments are irritated 



DISEASES OF THE ABDOMEN. 419 

and abused, and when this process is repeated a number of 
times, nausea and vomiting take place. 

In the recumbent position, head low, feet to the stern of boat, 
in which position nature has some beautiful anatomical con- 
trivances to prevent sickness. She has made provision for the 
equilibrium of the body in the horizontal position, by the 
change in position of the fluid at the base of the brain into 
the spinal cavity, in the position of the semi-circular canals 
on their present extremities. In consequence of these, when 
the body is recumbent or thrown back, the endo-lymph gravi- 
tates to the least sensitive part, and disturbance of them will 
not have that tendency to alter pressure. This explains why 
the backward motion in carriages causes nausea. In auditory 
vertigo we have precisely the same condition by pressure within 
the inner ear, decided vertigo, headache, nausea, etc. Motion 
sickness is a semi-physiological prototype of sea sickness. All 
authorities are agreed on the point that a reversion of the 
movement in the semi-circular canals is a cause of nausea, 
vomiting. This form most common in all steam ships, with 
sea motion and vibration of the engine. 

Second Class, — Visceral vomiting, due to mechanical disturb- 
ance of the viscera — contusion of the abdominal viscera, pro- 
duced by the violent heaving of the ship in a heavy sea, has a 
tendency to cause mechanical disturbance. Here, again, we 
are compelled to go back to the brain. The endo-lymph in 
canals follows the motion of the head, and after that motion is 
stopped, continues on its course for a second or two, and then 
moves on in its original direction. During this change erro- 
neous impressions are conveyed to the brain, which in turn 
sends a mistaken message to the abdominal muscles and vis- 
cera, and they are brought into action, and complete abdomi- 
nal contusion is the result. This is of the greatest importance 
to the viscera, altering their basis of support, and causes them 
to thump on each other. Besides, there can be little doubt, as 
the viscera are all covered by the sympathetic and the 
peeinian corpuscles, that their movement causes a disturbance 
of the centre of equilibrium. In this form vomiting is very 
violent. 

Third Class. — A mechanical disturbance of the fluid con- 
tents of the stomach gives rise to paleness, goneness and vomit- 
ing. Sea-sickness exists independent of visual impression, 
although it may exercise an important influence in some cases. 
Visual vertigo depends upon an exhaustion of the optic mech- 
anism ; but in the visual vertigo of sea-sickness there is a 
discord between the immediate impressions and a visceral 
sense of the fitness of things, which passes into a feeling of 
uncertainty, dizziness and nausea. 



420 DISEASES OF THE ABDOMEN. 

All the phenomena of sea-sickness have a rapid tendency 
to pass away. Nature has so constructed the organ of equi- 
librium that it is eminently fitted to receive impressions 
through the physical behaviour of the contents and habit 
taught that organ, to convey to the sensorium within, correct 
information of the experience of those impressions. The 
ocean habit teaches the canals to adapt themselves to the new 
condition of things, and to pass over erroneous impressions 
unheeded, which were noticed at first. In fact, the new habit 
becomes so strong that a disturbance of it by return to land 
will be marked by a peculiar phenomena, as is witnessed in the 
unsteady gait of a sailor, and others. 

Sea-sickness teaches us that there is within us a sense of 
passive motion. We see it in the child being lulled to sleep in 
the rocking horse, rocking chair ; horseback exercise, vehicular 
motion of all kinds, passive movements of the body. It is 
agreeable, when mild, and when in a line with the semi-circular 
canals ; disagreeable, when the natural harmony is broken. The 
feeling of goneness is due in a great measure to the subsidence 
of the abdominal in the erect posture, and irritation of the 
nerve-3entres by ceaseless movement of the ship. 

Best remedies to act on canals, sulphate quinine, nitrite of 
amyl, pills of nitroglycerine, bromohydric acid. 

Bandage round abdomen, recumbent posture, and, when 
about, face to the front of ship, etc. 

PERITONITIS. 

A partial death, or inflammation, of the serous membrane 
lining the abdominal cavity and investing the viscera; a white 
fibrous tissue of very low organization. Nothing so likely to 
ward off any depressing influence as strong vital force, and 
this is especially true with reference to the peritoneal mem- 
brane, for we find in a large per cent, of all cases that it is 
predisposed to by some depression of the sympathetic system, 
and that the common exciting causes, such as minor injuries, 
would be insufficient, were it not on account of this nervous 
depression. In the condition of partial death of this structure 
there is also a degradation of its normal living matter into a 
micro-organism or diseased germ, for we find that if a physi- 
cian is attending a case of acute peritonitis in a male, and by 
chance becomes the attendant in a case of parturition, the 
lady will become affected with peritonitis, severe or mild, 
according to her vital stamina, so that thus far there seems to 
be a living poison present. The general causes are injuries, 
perforation of stomach and bowels, strangulated hernia, dam- 
age done to organs in the abdominal cavity, as stomach, uterus, 
liver, etc. 



DISEASES OF THE ABDOMEN. 421 

(1.) Acute Peritonitis. — Acute inflammation of the peri- 
tonaeum is one of the most grave and serious calamities that 
can befall a human being. When not due to wounds, it is 
generally caused by injuries to organs, as the uterus, beginning 
as a case of metritis, or inflammation of that organ, and 
spreading over every organ in the visceral cavity. Originating 
in that manner it is called metro-peritonitis. 

Symptoms. — Chilliness or violent rigors, accompanied with 
severe, sharp, lancinating pain, extending over the entire 
abdomen, with high fever, small, hard, wiry pulse, abdomen 
swells, becomes exquisitely tender on pressure, even sensitive 
to the slightest pressure, as bed-clothes, or movement of abdom- 
inal muscles ; patient lies on back, with knees bent, legs drawn 
up ; abdomen becomes more enlarged, tense and hot, tympa- 
nitic or drummy ; motionless in respiration ; features become 
sharp, expressive of anxiety and suffering ; the tongue is sharp- 
pointed, dr}r, with a variable coat, according to the location of 
inflammation ; nausea, vomiting, constipation ; skin very dry 
and burning ; pulse becomes more rapid ; respiration hurried ; 
often hiccough. If case drags, the abdomen ceases to be tym- 
panitic, but remains enlarged from effusion of serum. If the 
injury is irreparable, or treatment ineffective, and the case 
about to terminate fatally, abdomen becomes more distended, 
pulse thready and quick, but intermittent ; face becomes of a 
ghastly expression, cold, clammy sweat, pain suddenly ceases. 
Unless due to perforation of stomach or bowels, the ordinary 
duration of peritonitis is about one week ; when due to perfor- 
ation, twenty -four or forty-eight hours. After sudden cessa- 
tion of pain, when about to terminate fatally, patient may live 
twent}^-four to thirt}^-six hours. 

Treatment. — The aim of treatment is to establish a renewal 
of life in the affected membrane . For effecting this purpose nar- 
cotism with opium, or its alkaloids, is our only resource. The 
first difficulty we have to contend with is in selecting the form, 
whether it be the crude pulverized opium alone, or with Dovers 
powders, or as paragoric, or the sulphate of morphia in cinna- 
mon water. The best plan is to try the crude pulverized alone 
or with of Dovers powder every half hour in half grain doses. 
If it answers the purpose of causing the patient to sleep, then 
push it; if it stimulates, try other forms until you find the one 
that answers the purpose. In conjuntion or in alternation, a 
few drops of tincture of green root gelseminum. If stomach is 
rejecting everything introduced, same remedies in suppositories 
or capsules per rectum, in double doses. At the same time, the 
attending physician or nurse, must select one of three remedies 
and apply over the entire abdomen; either a fly blister for six 
hours, or until it causes redness, or turpentine applied until the 



422 DISEASES OF THE ABDOMEN. 

same effect is produced, or tartar emetic ointment rubbed in 
over the entire abdomen. There is to be no blistering, as that 
is injurious, barbarous, draws off the liquor sanguinis of the 
blood. Whichever is applied, must be followed with large lin- 
seed meal poultices made with glycerine and one or more 
ounces of tincture of opium incoporated in it. Change every 
two or three hours. If there is any delay in procuring the 
above articles put on hot poultices of anything that will hold 
heat and moisture, until proper remedies can be procured. 

Local stimulants to the entire abdomen are of the greatest 
value ; they promote vitality, create a renewal of life ; their 
use is founded on sound principles, for it is a law of physiology 
that when two parts are nervously in sympathy with each other, 
that if we excite a greater action in the nerves of one, we distract 
action from the nerves of the other The blister or turpentine 
to erythema is a powerful means, it cures by withdrawing ner- 
vous action from the nerves of the part, and followed by hot 
poultices induces contractility of bloodvessels and a renewal 
of life. As soon as the skin begins to pour out a copious sweat, 
and stertorous breathing take place, patient must be turned 
over on right side, carefully watched, and as a rule ten to 
twelve hours of narcotism is sufficient. Then waked up and a 
little barley-water, or lime-water and milk given. If there 
are any indications of sinking, aromatic spirits of ammonia. 
The opium, gelseminum and hot poultices should be continued 
for about a week, the two former in small doses, at intervals 
of three or four hours apart. Cautiously and carefully begin 
with a little diet, as milk and water, beef-tea, essence of beef. 
Enemata of warm castile soap water daily, to remove all fecal 
accumulation in colon or rectum. A cradle over abdomen to 
support bed clothes; most perfect quiet obtained. The best 
of nursing and care, air of sick room to be kept warm and 
pure ; carry case over seventh day, then treatment for chronic 
peritonitis should be adopted. 

(2.) Chronic Peritonitis may be a sequel of an acute attack ; 
more frequently an independent affection. It may arise from 
cold, suppression of menses, miscarriage, mechanical violence, 
such as blows, rheumatism and gout, ovarian, irritation. In 
children, it is associated with deposit of tubercle. 

Symptoms. — General languor, lassitude, debility, with ab- 
dominal pain, sharp and lancinating, tender to pressure, and 
considerable swelling of abdomen ; sometimes slight fever, with 
obstinate diarrhoea, nausea, wasting and prostration. If case 
progresses, a good deal of abdominal tension ; often effusion of 
lymph, with adhesions, which give rise to colic. In some cases, 
effusion of serum or ascites is immense. In chronic tubercular 
peritonitis in children, there is usually enlargement of mesentery . 



DISEASES OF THE ABDOMEN. 423 

Treatment. — Patient should go to bed for a few weeks, until 
every vestige of pain has disappeared ; being treated in the 
same manner as if the case was acute, with opium, gelseminum 
and local stimulants. As soon as pain has disappeared, altera- 
tives and tonics, as ozonized saxifraga, iodide of potassa, ozon- 
ized glycerine, cinchona and mineral acids, tincture of white 
bryony. To the abdomen, ozonized clay, if effusion of lymph 
is suspected, or iodoform ointment, or ozone ointment, iodide 
of cadmium ointment ; and over all a flannel roller ; great atten- 
tion to the bowels and diet ; milk and lime-water, raw eggs, 
raw extract of meat. 

DROPSY OF THE ABDOMEN. 

Ascites, or water in the cavity of the abdomen, may arise from 
two causes, peritonitis and disease of the liver. 

(1.) From all forms of peritoneal irritation, it may take place 
as the result of the existing inflammation, but when the cavity 
becomes pretty w r ell filled up it arises from the distension and 
unraveling of the peritoneal fibres or sacs. 

(2.) Chronic affections of liver, as chronic inflammation, 
causing enlargement, distension of its peritoneal covering, 
obliteration of its proper structure by fatty, amyloid, cystic 
degeneration, blocking up portal vein, obstructing passage of 
blood through the liver. 

Besides these two principal conditions, there may be ascites 
in disease of the heart, spleen, kidneys ; but it takes place 
chiefly by the blending of the circulation of those organs with 
the liver. It may occur, also, in extensive burns, anaemia, etc. 

Symptoms. — The physical appearance of the patient will 
depend a good deal on the point whether the dropsy arises 
from the obstruction in the liver or from chronic peritonitis. 
If from the liver, the history of the case, the brown coat on 
tongue, sallow or yellow skin, cough, dullness on percussion of 
upper lobe of right lung, pain in shoulders, liver small or large, 
urine loaded with bile ; whereas, if from chronic peritonitis, 
none of those symptoms will likely be present; upper part of 
body wasted, features pinched, countenance anxious, abdomen 
greatly enlarged, skin shining, superficial veins dilated. In 
standing up, spreading fingers of left hand over right side of 
the abdomen of the patient, and tapping gently with the right 
hand the left side of abdomen, a wave or sense of fluctuation 
can be felt undulating from side to side. This fluctuation or 
vibration is most reliable. Empty bowels with castor oil, lay 
patient in recumbent posture; then there is resonance on 
percussion; bowels floating on top of water. Besides there is 
a sense of suffocation in recumbent posture, from water press- 
ing up on diaphragm ; difficulty of breathing ; respiratory 



424 DISEASES OF THE ABDOMEN. 

murmur cannot be heard so low down as in health ; tubular 
breathing ; apex of heart elevated and pressed to right side. 
Commonly there is swelling of the feet and legs, and if kidneys 
suffer, cedema of face and arms. Health gradually deteriorates, 
weakness and emaciation, loss of appetite, sleeplessness, inability 
to lie down, exhaustion ; ending fatally, when due to organic 
disease of liver. 

Treatment. — If due to chronic peritonitis, the remo val of 
the fluid will usually effect a cure; if due to organic disease 
of the liver, the water may be removed again and again, and 
it will re-accumulate, because the cause does not permit of 
removal. If about to attempt its removal, build up patient 
with tonics and best of diet ; then begin with infusion of digi- 
talis, and follow up with diaphoretics, diuretics, haircap moss, 
and hydragogue cathartics ; those failing, try absorbents, such 
as iodide of potass. 

Remedies failing, place patient in a sitting posture, with long 
bandage round abdomen, held by two assistants, one at each 
side ; insert trocar and canula, with a gentle rotatory move- 
ment through the abdominal wall in the median line, two- 
and-a-half inches below the umbilicus ; as soon as water is 
felt on fingers, withdraw the trocar, and the fluid will ooze 
through the canula ; assistants tightening the bandage as fluid 
escapes. After it is entirely removed a compress should be 
applied, and over all a bandage. Opium in sufficient doses 
should be given ; patient kept in bed, and, after several days, 
bowels opened with oil and enemata. (See Dropsy.) 

MARASMUS, OR TABES MESENTERICA. 

Marasmus, or tabes mesenterica, a weakened, relaxed or devi- 
talized condition of the mesenteric glands, usually caused by 
diarrhoea or cholera infantum in tubercular children under 
two years of age, whereby these glands become infiltrated 
with the germ tubercle, which lodge in its meshes or net-work, 
breed and grow with great rapidity, filling up its tissue, destroys 
its proper function, and their growth obstructs the passage of 
chyle through the convoluted lacteals which traverse the 
mesentery in all directions ; consequently the blood is deprived 
of supply, and all the tissues of the body starve and waste away. 

Symptoms. — Usually associated with diarrhoea or cholera 
infantum ; abdomen becomes hot and tender ; bloats ; more or 
less constant pain in the bowels, sometimes severe, causing legs 
to be drawn up towards abdomen ; deep red color of lips ; 
angles of mouth covered with small ulcers, or lips fissured; 
passages from the bowels, which resemble chopped spinach, and 
very acid, now become more irritating and irregular, more 
frequent, watery, unhealthy and foetid ; abdomen swells and 



DISEASES OF THE ABDOMEN. 425 

becomes tense and greatly enlarged ; at the same time the 
emaciation is fearful ; the patient gets down to skin and bone; 
even the marrow in bones wastes ; skin white and wrinkled ; 
intense debility, with rapid, increasing weakness. The abdo- 
men, although intensely swollen, soon becomes irregular to the 
feel, lumpy in masses like large eggs at first ; when tubercle is 
active and growing, soft ; then a cheesy feel, and latterly calca- 
rious ; there may be a tubercular condition of lungs, bronchi, 
or membranes of brain. Its duration is uncertain, depending 
on the condition of vital force and season of the year. If it 
appear early in June, the little sufferer, unless taken to the sea- 
shore or country, stands a poor chance of recovery before Sep- 
tember ; whereas, if it appears in August, there is usually little 
difficulty in tiding the patient into the cool weather. It may 
occur at any season, but much more common when the vital 
forces of the child are depressed by solar heat and city life — 
season when cholera infantum is prevalent. 

Treatment. — If possible, get rid of the cause by an emetic, 
cleaning out bowels, administering white hellebore in tincture, 
and other remedies for cholera infantum. 

For checking the effusion and growth of tubercle in the 
mesentery, ozonized clay should be applied a few hours daily 
over the entire abdomen — not long enough to cause redness ; 
after its removal a spice plaster, made of equal parts of pulver- 
ized cloves, allspice, cinnamon, and Peruvian bark, saturated 
with vinegar or alcohol ; spread between fine book-muslin, then 
applied, and over all the flannel roller ; when it cakes it can be 
crumbled up, moistened with the alcohol and re-applied in the 
same form. The potent antiseptic properties of the clay and 
spices penetrates by endosmosis to the tubercle in the mesen- 
tery, and destroys it ; besides, their stimulating properties in 
arresting vomiting, and increased activity of bowels, prevents 
further deposits. 

To destroy tubercle in the blood and mesentery, use ozone-water 
or glycerite of ozone, or tincture of iodine in sweet milk, or 
hypophosphite of potassa in juice of meat, or tincture of iodine 
and carbolic acid ; one or two of these remedies should be given 
every two hours, according to preference. 

To prevent emaciation, bath twice daily ; and after each bath 
or sponging, inunction of warm olive oil into the entire body : 
from one to three ounces should be gently rubbed in, and juice 
of raw meat fed every hour. Raw food or meat extracts make 
blood faster than any other form of diet. Raw extracts are 
peculiarly available in tabes mesenterica. These are to be 
used irrespective of the mother's milk. Mother's milk, if child 
is still nursing, is the best and most natural food for the infant, 
and never can be completely substituted by artificial nourish- 



426 DISEASES OF THE ABDOMEN. 

ment ; but if the child is weaned, rather than risk diseased 
cow's milk, which is so abundant, milk-food should be given, 
which, if prepared by the German method, is free from all dis- 
ease germs. Raw eggs; allowed to suck partially-broiled steak. 

To destroy the oidium albicans in mouth, borax and glycerine. 

To stimulate appetite, sulphate of quinine in aromatic sul- 
phuric acid. 

Warm clothing, country or sea-shore, well ventilated rooms, 
and everything calculated to build up vital force. 

Tubercular Peritonitis consists in an effusion and growth 
of tubercle upon the peritoneal membrane. Its cause and symp- 
toms closely resemble tabes mesenterica. 

Tubercular Enteritis. — Deposit of tubercle on the internal 
lining membrane of the bowels has also a striking resemblance 
to marasmus. Very often these diseases are combined in one 
patient. 

Tubercular peritonitis and enteritis, without any filling up 
of the mesentery, are much more easily treated, and recovery 
more rapid. Treatment same as tabes. 

DROPSY. 

Not a disease, a mere mechanical or pathological effect, con- 
sisting in the effusion of watery or serous fluid into one or more 
of the serous cavities of the body, or in the meshes of the cellu- 
lar tissue, or in both. 

The two common causes are inflammation and obstruction 
from debility and organic disease ; more rarely it is due to 
disease of the blood, burns, etc. 

Dropsy of the Head, or Hydrocephalus, is almost invariably 
due to inflammation of the membranes of the brain and effusion 
of serum. It is known or recognized by the history of the case, 
usually a child of tubercular diathesis, commenced under two 
years of age, by enlargement of the head, a parting of the sutures, 
head weighty, inability to hold it up, blindness, deafness, men- 
tal imbecility or paralysis. 

Dropsy of the Chest is either due to pleurisy or valvular 
disease of heart. Hydrothorax, or water in the chest, is recog- 
nized by the history of the case : great difficulty of breathing from 
lungs being pressed with a fluid, and this difficulty increased to 
absolute smothering if the recumbent posture is assumed; besides 
dullness on percussion at the base of chest in sitting posture, 
which disappears if laid down, as the lungs float on top of the 
water or fluid, and the splashing sound, which is supposed to 
be heard if quick movements are made, said to resemble the 
dropping of a drop of water in a barrel almost empty of water. 

Dropsy of the Pericardium is caused either by valvular dis- 
ease or inflammation, and is recognized by the contracted or car- 



DISEASES OF THE ABDOMEN. 427 

diac features, difficulty of breathing, OBdema of the feet, cough, 
increased area of dullness on percussion, and sounds of the heart 
muffled, and absence of all symptoms of enlargement and dila- 
tation. 

Dropsy of the Abdomen, or Ascites, is due either to dis- 
ease or degeneration of the liver, or to peritonitis, and is known 
by the history of the case: enlarged abdomen, sense of fluctua- 
tion, oedema of feet and legs. 

Dropsy of the Cellular Tissue is due to contraction or caving 
in of kidneys, interstitial obliteration, as in Bright's disease; it 
may begin with a puffinesss of ankle or bagging below eyes, or 
slight swelling in some depending part, and increase until the 
cellular tissue over the entire body is infiltrated. Organic dis- 
ease of heart, degeneration of liver, poor blood, as in anaemia, 
chlorosis, leucocythgemia; purpura and scurvy may also give 
rise to this form of dropsy to a limited extent, but never like 
disease of kidneys. 

The dropsy may be removed by the proper remedies again 
and again, but if due to any form of organic disease of heart, 
liver or kidneys, it will return, until the cause is removed. 

Treatment. — In the removal of dropsical effusions there 
are some points to be observed, which we will enumerate in 
order : 

(1) The Diet. — It is of vital importance that the patient 
have a good appetite, active digestion, and abundance of good 
food, as beef, mutton, poultry, fish, eggs, cream, fruit and vege- 
tables. We need above all things rich blood ; rich, so that 
neither its watery elements or liquor sanguinis can permeate 
through the walls of vessels ; tonics as cinchona, mineral acids 
and pepsine are to be used to bring about a good digestion ; 
bowels to be regulated. 

(2) External warmth, by flannel clothing and warm apart- 
ments. 

(3) Before attempting the removal of the fluid, bring the 
arterial, venous and capillary systems together with the absor- 
bents under the influence of digitalis. To brace up the heart, 
tighten the walls of arteries and veins, the tincture should be 
given in eight-drop doses three times a day. To unlock the 
absorbent system, to flush and prepare the kidneys for pouring 
out fluids, the infusion to be made as we have laid down, and 
in doses of from a tablespoonful to a wineglassful three times 
a day, until it produces its cerebral effects — moodiness, despair ; 
then stop a day or two and begin again ; may take a week to 
effect this. Now is the opportune moment to push diaphoretics, 
diuretics, hydragogue cathartics, for it is by these we are going 
to get rid of the serum. 

(4) Diaphoretics. — The use of vapor bather every other day, 



428 DISEASES OF THE ABDOMEN. 

with warmth, with the jaborandi in fluid extract, or pilocarpin, 
one third of grain by hypodermic injection. If this remedy 
is used no drinks and patient must positively spit out saliva. 

After skin has completed pouring out its secretion in immense 
quantities, either same evening or next morning, follow in 
with 

(5) Diuretics. — An infusion of haircap moss should be drank 
freely ; it causes the kidney to eliminate water abundantly. 
At the same time the use of hydragogue cathartics should be 
commenced. 

(6) Hydragogue Cathartics. — One-twelfth of a grain of elaterin 
every three hours, will bring away copious watery evacuations 
from the bowels. Those three remedies are our best, jaborandi 
for skin, digitalis for kidney, elaterin for bowels. 

Besides these three powerful remedies there are numerous 
others of a milder description. — Diuretics : Infusion of squills, 
nitrate and bitartrate of potassa, buchu, uva ursse, senega, 
cider and nitrate of patassa, parsley root, juniper berries. 

Diaphoretics. — Infusion of asclepias,eupatorium. elder flowers. 

Cathartics. — Podophyllum, acid tartrate of potassa, colocynth. 

If above fails, then use alteratives and tonics and return to 
the above, giving each method a fair trial of about a week, 
changing, alternating. 

There is a form of general dropsy met in hot latitudes, in 
which hydrothorax, ascites, and genera ldropsy of thecellular 
tissue, are all present in one case. It seems to depend on 
endemic and malarial causes; it is very fatal to the unacclima- 
tized. It is characterized by anaemia, debility, anxiety, numb- 
ness of the body, difficulty of breathing, paralysis, exhaustion, 
with suppression of urine, and death. 

The general treatment, as already laid down, should be tried, 
with quinine, iodine, and nourishing diet. 

CONTUSIONS OF THE WALLS OF THE ABDOMEN. 

Injuries inflicted by obtuse or blunt bodies, as falls, blows, 
kicks against some round object, or a jam between two railroad 
cars. The consequences of an abdominal contusion, even a 
blow on the stomach, to be regarded as serious. A blow may 
cause instant death, owing to syncope or shock to solar plexus 
of sympathetic. In other cases, contusion may cause bruising 
or laceration of the viscera, and haemorrhage may result, and 
cause death in a short time, or in a few hours. The contusion 
may even rupture some internal organ, and permit extravasation 
of its contents. There may be no appearance of external injury, 
and yet the stomach, gall-bladder, intestinal canal, bladder, or 
pregnant uterus may be torn through — patient dying from col- 
lapse or haemorrhage; or at a later period, from peritonitis or 



DISEASES OF THE ABDOMEN. 429 

suppuration and blood poisoning. A contusion, if not very 
violent, may simply lead to local abscess, from which recovery 
may take place. 

ABSCESS OF THE WALLS OF THE ABDOMEN. 

Abscess ot the walls of the abdomen may result from quite 
a variety of causes, as external violence, irritation of belts, boils, 
erysipelas, or from extension of disease in other parts. From 
external violence, abscess may occur at any part of the abdomi- 
nal walls ; from the irritation of belts, generally below or near 
the umbilicus; from boils and erysipelas, at any point; from 
the extension of disease in other parts, such as in abscess of the 
liver, the peritoneal covering of the liver uniting with that of 
the abdomen, and irritation, inflammation, ulceration of the 
abdominal walls, matter finding its exit externally; inflamma- 
tion, effusion of lymph and suppuration of vermiform appen- 
dix of csecuin, the pus forming a channel to the surface in the 
right inguinal region ; suppuration may take place in areolar 
tissue of the pelvis ; in either ovary in broken-down, strumous 
women ; abscess may point in the groin, or in vagina or bowels ; 
from blows, strains, violence, there may be a suppuration 
around the kidneys, and the abscess may point in the loins or 
may find its way into the ureter, or burrow amongst the 
abdominal muscles ; or find its way into the peritoneal cavity. 
In chronic peritonitis the pus, confined by adhesions, may 
approach the surface and find an exit. In all forms, abscess to 
be carefully opened ; when it points, and if in doubt, use an 
exploring needle ; poultices applied ; strength to be supported 
by good food, tonics, and everything done to relieve pain and 
suffering. 

RUPTURE, OR HERNIA. 

A tumor or swelling, formed by the protrusion of more or 
less of a viscus from its natural cavity. Thus, there may be 
hernia of the brain, iris, mucous lining of windpipe, lungs, 
liver, spleen, bladder, uterus and intestine. But when the word 
stands by itself it is restricted to signify protrusion of the 
abdominal viscera. 

The predisposing cause of hernia is some inherent weakness 
of organization ; some parts of the abdominal walls weaker 
than others, as about the navel, inguinal and crural rings; or 
there may be a weakness from congenital deficiency, or from 
disease, wounds, abscess, bruises, distension of the walls by the 
pregnant uterus, dropsy, or from the relaxing effects of exces- 
sive solar heat. 

The exciting causes are compression of the viscera by the 
action of the muscles that surround them, especially the dia- 



430 DISEASES OF THE ABDOMEN. 

phragm; hence, bodily exertion, lifting, hoisting, straining, 
jumping, coughing, hallooing, shouting. 

A hernia is composed of a sac and its contents. The sac of 
a hernia is a portion of the reflected layer of peritonaeum, 
which the protruded viscera push before them in their escape, 
and which forms a pouch containing them. It is very liable 
to contract adhesions to the surrounding tissue, and in conse- 
quence may not return into the abdomen when the hernia is 
returned. As the hernia increases in size the sac also increases, 
partly by growth, partly by distension, slight laceration or 
unraveling, and partly by fresh peritonaeum ; sometimes it 
diminishes in thickness, while increasing in capacity ; some- 
times it becomes thick and divisible into layers. The narrow 
part that communicates with the abdominal cavity, is called 
its neck, usually becomes thickened, constricted, and sphincter 
fibres are often developed in it, which, on slight irritation, 
causes it to contract. Some hernias are destitute of a sac. This 
may happen if the viscus is not coveredby peritonaeum, if the 
hernia is the result of a wound. 

Symptoms. — Usually the patient can speak of it as of some- 
thing having given way, and on examination a soft, compres- 
sible swelling can be detected at some part of the abdominal 
walls, which increases in size when he stands up ; diminishes 
or disappears when he lies down ; dilates when he coughs or 
makes exertion, and, when properly directed pressure is made 
upon it, it may disappear. When it contains only intestine it 
is termed Enterocele; when only omentum, Epiplocele. The 
former is smooth, round and elastic, and flatulent croakings 
are heard in it, and, when pressed upon the bowel returns to 
the abdomen with a sudden jerk or gurgling noise ; the latter is 
flat, inelastic, flabby, unequal to the touch, and when pressed 
upon returns without any noise and very slowly. A large 
number of hernia contain both omentum and bowel, and are 
called entero-epiplocele. 

Division. — Hernia is divided into several varieties, according 
to its location, as umbilical, inguinal, femoral ; and according 
to the condition of the protruded viscera, which may be reduci- 
ble, irreducible, or strangulated, or subject to some constriction 
thatpre\ents its return, interferes with its contents or circulation. 

1. Reducible Hernia. — One that can by well adapted press- 
ure or manipulation be returned into its natural cavity, forming 
aswelling that dilates on coughing, diminishing or disappearing 
when patient lies down. 

Treatment. — It should be kept in its position by a pad, com- 
press, truss, or other apparatus; and if compression is mode- 
rately firm it will excite adhesive inflammation, and very 
probably a cure. 



DISEASES OF THE ABDOMEN. 431 

2. Irreducible Hernia. — A hernia is said to be irreducible 
when the protruded viscera cannot be returned into the abdo- 
men. 

Causes. — Adhesion of the sac to the bowel, by a deposit of 
lymph bands ; enlargement of mesentery, or omentum, or other 
organic changes. 

Symptoms. — Besides the ordinary symptoms, there is likely 
to be a dragging pain in the back and abdomen; occasional 
attacks of vomiting, or obstinate constipation, and a feeling of 
exhaustion. 

Treatemnt. — This may be either palliative or radical. The 
palliative treatment consists in the application of a hollow bag 
truss, or else a truss with a hollow pad, that shall firmly embrace 
the hernia, and prevent all further protrusion. Violent exer- 
cise, exertion, excess, or constipation, should be guarded against. 
The radical operation consists in cutting down upon the parts, 
breaking up adhesion, returning the bowel or omentum. An 
operation that is not justifiable unless strangulation has taken 
place. 

3. Strangulated Hernia. — A hernia may be said to be stran- 
gulated when it is constricted in any way, so that the contents 
of the protruded bowel cannot be propelled onwards, and the 
return of the venous blood is impeded. 

Causes. — A sudden protrusion of bowel or omentum through 
a narrow aperture, as a result of some violent exertion, or dis- 
tension of the protruded intestine by flatus or faeces, or a tume- 
faction of the omentum, a swelling or contraction of the mus- 
cular fibres at neck. 

Symptoms. — In addition to the ordinary symptoms of her- 
nia we have, when it is strangulated, those of obstruction of 
the bowels, and peritonitis. There is flatulence, colicy pains, a 
sense of tightness around the abdomen, a desire to defecate, and 
inability to do so. Vomiting, first the contents of stomach, then 
mucous bile; and lastly, matter from small intestine. Thehernial 
tumor cannot be returned; it is uneasy or painful, tense and 
incompressible. There is a perfect obstruction; the swelling 
does not now dilate. The neck of the sac becomes tender, and 
this tenderness diffuses itself over the entire abdomen, which 
becomes painful and tympanitic. Peritonitis sets in : face white, 
pinched, anxious; vomiting constant, pulse small, hard, wiry; 
patient restless and despondent, and after a variable time parts 
begin to mortify. There may be much variety in the symp- 
toms, death taking place early or remote. 

Treatment. — The indications here are to return the intestine, 
and if this cannot be done to cut down upon the neck and 
divide it, and return the bowel and omentum. If inflamma- 
tory symptoms have not appeared, the best plan is to relax 



432 DISEASES OF THE ABDOMEN. 

the muscular system by one or more of the following methods, 
and then perform the taxis : 

To cause profound relaxation, you must be guided by what 
you can procure the quickest, and if it fails, then the others, 
one or more. We shall enumerate the best first, and so on ; 
they are simply auxiliary measures to aid the taxis. Let 
patient inhale a little chloroform, and when he is just going 
under, insert a hypodermic injection of one-quarter grain of 
morphia into the cellular tissue. This causes very profound 
muscular relaxation, and lasts long. Or let patient inhale 
alcohol, chloroform, and ether, till anaesthesia is procured; ene- 
mata of an infusion of lobelia or tobacco ; with warm bath, 
with a little tobacco or lobelia, or an infusion or fluid extract 
of jaborina could be given. 

If there is any time to spare, large doses of opium and hyos- 
ciamus ; the latter drug has a remarkable influence over all the 
hollow viscera; and its liberal use in hernia often spares the 
surgeon's knife, and saves many lives. As a local application, 
heat is superior to cold : hot poultices of belladonna, lobelia and 
linseed. Once thoroughly relaxed, patient free from all clothes, 
an intelligent assistant should be selected, and instructed to 
knead, or press the bowels gently well up to the diaphragm ; 
head and shoulders well elevated, and knees drawn up. Bladder 
and rectum carefully emptied before relaxant is administered. 

The Taxis is a term employed to signify the manipulation of 
the hernial tumor by the hands of the surgeon. In perform- 
ing the taxis the tumor should be drawn gently forward, 
between both hands (assistant kneading actively to diaphragm), 
in the aeris of the neck. Hold in this position a few minutes ; 
if patient is awake cause him to make a deep exspiration, and 
hold his breath. Then press tumor between both hands, so 
as to squeeze out its contents, or gas and venous blood ; then 
manipulate with the fingers at the neck ; by pushing a little 
you will likely have the satisfaction of feeling it leave your 
hands and hearing a gurgling noise accompanying the return 
of the bowel into its natural cavity. To effect this, the posi- 
tion of the patient should be such as will relax every muscle ; 
the kneading must be vigorously carried out, and the tumour 
in all cases drawn gently forward. In all cases the taxis must 
be performed with gentleness ; no force or violence to bruise or 
injure. If not successful by the above plan, which is rarely the 
case, after a trial of fifteen or twenty minutes, it is often better 
to rest a little, and try again. Try every means, even to intro- 
ducing copious injections up the rectum, or hanging up the 
patient by the heels. Good common sense, kindness and pati- 
ence are great elements of success. When once returned, if 
insisted on by the patient, and his friends concurring, a radical 



DISEASES OF THE ABDOMEN. 433 

cure should be effected by some of the following methods, each 
one having the same object in view, to wit : to excite a slight 
irritation, so as to cause inflammation, with effusion of lymph, 
which will block up the orifice and render the descent of the 
bowel again impossible. For that purpose the following are 
successfully used : 

If the parts are hairy, shave off, and apply the irritating 
plaster for about six weeks, and over it the truss, or pad, or 
compress. This plaster is to be spread fresh every morning, 
and applied, in size from three to four inches square. A good 
method, somewhat painful and tedious, but safe. Another plan 
is to introduce a small knife and scarify around the ring. Still 
another method, and a favorite one with many, is to inject 
right against, or in the inner surface of ring, some irritant, 
such as fluid extract of oak bark, tincture of cantharides, tinc- 
ture of iodine; this is done with the ordinary hypodermic syringe, 
or one specially prepared for the purpose. If those are used, case 
must be watched for peritonitis. Still another plan is the 
introduction of sutures of saddlers' silk, iron or silver wire, and 
other methods of a similar kind. 

If strangulated hernia cannot be reduced, an operation for 
its relief must not be too long delayed; and when that is done, 
if successful, it invariably effects a radical cure. Although we 
say do not delay the operation, still, in aged people, with large 
hernias, wait as long as possible and use remedies, and never 
forget the magnificent action of hyosciamus and opium on the 
hollow viscera. 

The operation is a simple one, free from danger, if the sur- 
geon knows the parts and does not cut an artery or wound the 
bowel — dividing layer after layer over the tumor near its neck, 
down to the bowel, and then dividing the neck and returning 
the bowel or omentum, or both, into the abdomen, stitching up 
wound in the usual manner and applying a firm compress. In 
all cases avoid purgatives in the management of cases, as irri- 
tating and injurious. 

INGUINAL HERNIA. 

Inguinal hernia is that which protrudes through one or both 
abdominal rings. There are four different varieties — oblique, 
direct, congenital and encysted. 

The oblique is the most common. It takes precisely the same 
course as the testicle takes in its passage from the abdomen 
into the scrotum. It begins as a fullness, or swelling, at the 
internal ring, a little above Poupart's ligament, and passes into 
the inguinal canal, and, if the protrusion increases, it descends 
into the scrotum of the male, or labia of the female. The cov- 
erings of this hernia are skin, a layer of condensed cellular 

40 



434 DISEASES OF THE ABDOMEN. 

tissue, a tendonous layer, cremaster muscle, a cellular layer and 
the sac. The internal epigastric artery is always internal to 
the neck of the sac, the spermatic cord behind the sac, but in 
old cases parts are somewhat changed. 

The direct inguinal bursts through the conjoined tendon of 
the internal oblique and transversalis muscles, just behind the 
external ring. Its coverings are the same as the oblique. The 
epigastric artery runs external to the neck of the sac. 

The congenital hernia is a variety of the oblique, and is so 
called because the state of the parts admit of it at birth. 

The encysted is a variety of the congenital. The protruding 
bowel pushes before it a sac of peritonaeum, either into or 
behind the tunica vaginalis, and this tunic and sac adhere 
together, so that this hernia has two sacs. 

Diagnosis. — This hernia is to be distinguished by dropsy of 
the scrotum, as follows : Hydrocele begins at the bottom of 
the scrotum; there is fluctuation; if the serum is not turbid it 
can be seen through ; does not dilate on coughing ; whereas, 
hernia begins at top, is not transparent, does not fluctuate, 
dilates on coughing. In varicocele, wdiere there is a varicose 
condition of the veins of the cord, it resembles hernia, as it 
dilates on coughing, increases in erect posture, may disappear 
at night, but it feels like a bag of worms. Undescended testi- 
cles are very easily recognized. 

Treatment. — If reducible it should be returned and kept in 
its place with a truss or other mechanical support ; if irredu- 
cible, a hollow bag or truss should be worn, to prevent further 
protrusion; if strangulated, relaxants and the taxis should be 
resorted to, and if it fails, and trying every expedient, an 
operation should be performed. 

In performing the taxis for this hernia, patient should be 
placed on back, head and shoulders well elevated, knees drawm 
up and thighs close together, the hernia drawn gently down ; 
then the assistant actively kneading the bowels well up to 
diaphragm and the pressure by the operator made upward and 
outward. 

FEMORAL OR CRURAL HERNIA. 

Femoral hernia is that which escapes behind Poupart's liga- 
ment, passes through the crural ring and descends on the thigh. 
This hernia is covered by skin, fascia of the thigh loaded with 
fat, a layer of cellular tissue and sac. From its surroundings 
it never can become of great size. It is almost peculiar to 
females, on account of the extreme breadth of their pelvis. It 
is easily recognized by its location, increasing in size when she 
stands up, dilating in coughing; it is usually small. Psoas 
abscess also dilates when she coughs, diminishes or disappears 



DISEASES OF THE ABDOMEN. 435 

when the patient lies down ; but hectic and disease of the spine 
are always present in that form of abscess. Varix of the femo- 
ral vein bears some likeness to it, as it dilates when the patient 
coughs, diminishes or disappears when she lies down ; but a 
careful observation will reveal the difference. It would certainly 
be a person grossly ignorant that would mistake it for bubo. 

Treatment. — The reducible should be returned and kept in 
position b} T a truss. The irreducible supported by a hollow truss. 

If stranglated, the taxis must be tried, and in performing 
this the patient should be placed in the usual position on back, 
head and shoulders elevated, knees drawn up, with the thigh 
of the affected side rolled inward and crossed over toward the 
other side. The tumor should be drawn downward, the 
kneading vigorously carried out, and the tumor pressed with 
the points of the fingers backward and upward. If the taxis 
and chloform do not succeed, the operation should be resorted to. 

UMBILICAL HERNIA. 

Rupture at the navel is most common in children at birth, 
and in women who have been frequently pregnant ; although 
in the so-called hernia of adults, the hernial aperture is really 
not at the umbilicus, but a little on one side of it. The cover- 
ings of this hernia are skin, superficial fascia and sac. They 
are always thin and rarely become adherent. 

Treatment. — If reducible, there should be strapped over 
the ring or neck a convex piece of some hard substance, its 
convex side toward the abdomen, strapped to the abdominal 
walls by adhesive plaster, and over all a bandage or belt. The 
irreducible should be supported by a hollow bag or truss. If 
strangulated, the taxis should be resorted to ; patient in usual 
position ; all failing, an operation should be resorted to. 

Ventral Hernia. — When the protrusion occurs at any other 
part of the abdominal walls, save at the ordinary places, usually 
a consequence of wounds or bruises. 

Perineal Hernia. — Descends between the bladder and rec- 
tum, forcing its way through the pelvic fascia and levata ani. 

Vaginal Hernia. — In which the tumor projects into and 
blocks up the the vagina, displaces the uterus, obstructs the 
rectum. Very common cause, usually, tight lacing or wearing 
belts, in order to have a small abdomen. 

Labial or Pudendal Hernia. — Descends between the vagina 
and ramus of the ischion, and forms a tumor in one of the 
labia. It is to be distinguished from inguinal hernia by the 
absence of swelling at the abdominal rings. These hernias are 
to be replaced by pressure with the fingers, and kept in place 
by pads and trusses. 

Obturator, Ischiatic, and Diaphragmatic Hernia, so- 
called from their location, are verv rare. 



436 DISEASES OF THE LYMPHATIC SYSTEM. 



DISEASES OF THE LYMPHATIC SYSTEM 



After the food has been subjected to the action of the salivary 
secretion in the mouth, to the pepsin and gastric juices of the 
stomach, and lastly, to the emulsifying action of the pancreatic 
secretion in the duodenum, the chylous product is carried into 
the lymph channels of the mesentery, into the lymph canals, 
widely spread over the entire body, but most abundant in the 
neck, axilla, groin, the suprarenal capsules, spleen, and the 
pink marrow of the bones. These constitute the great chain of 
lymphatics, through which the chyle passes before it is emptied 
into the venous circulation as embryonic blood. And a disease 
or disorder, or derangement of any of those lymph-raising fac- 
tories, gives rise to the most persistent anaemia, or white cell 
disease of the blood. Under other heads in another part of 
this work, we have noticed the diseases of the spleen, that duct- 
less gland, that storehouse of red blood and lymph vitalizer; 
tabes mesenterica or marasmus in disease of the mesentery; the 
suprarenal capsules under Addison's disease, and Hodgkin's 
disease, under general derangement of the lymphatics. 

The pink marrow in the cancellous bones belongs to this same 
class of organs, and probably discharges most of the functions 
of the ordinary lymph glands. Living germs in the blood, 
such as tubercle, cancer, syphilis, etc., are very liable to irritate 
and impair those canals, and give rise to very chronic inflam- 
mation and degeneration. Now, as we find pink marrow in 
the ends of the long bones, in the bodies of the vertebrae, in the 
bones of the hands and feet; and when those disease-germs are 
present in the blood we often find the same conditions present 
that we find in those of the cellular tissue, the same sluggish- 
ness, the same tendency to degeneration. A lymphatic in the 
neck or groin has room to swell, if inflammation should occur, 
and if it suppurates its contents can excite ulceration and per- 
foration, and be discharged from the system. But this cannot 
be so easily done in bone glands, which are bound down inside 
of a bony wall or shell, and the swelling, which is a sequence 
of the inflammation, results in compression and strangulation. 
We have beautiful examples of this in the wrist and hand, in 
the head of the thigh bone, in hip-disease, so called, and in 
white swelling at the knee-joint; in those bones when the in- 
flammation is permitted to proceed, the inflamed and suppu- 



DISEASES OF THE LYMPHATIC SYSTEM. 437 

rating tissues force an outlet wherever they can most easily 
effect it. The compact shell is thinned, and the inflamed mar- 
row takes its course into the joint, through the articular car- 
tilages. When the marrow abscess bursts into a joint a form 
of suppurative^ synovitis is set up, and the joint soon becomes 
disorganized. 

There is, perhaps, no subject of greater interest in the whole 
range of practical medicine than lymphatic disease, and one 
not understood or even appreciated by the ordinary physician. 

ADENOMA, OR HODGKINS DISEASE. 

A peculiar disease, in which there is a progressive enlarge- 
ment of nearly all the lymphatic glands by an increase of glan- 
dular structure. 

Symptoms. — Gradual painless enlargement of nearly all the 
lymphatic glands. Glands of neck, axilla, groin symmetrically 
enlarged, not inflamed or fused together; thoracic and abdomi- 
nal glands also affected. Patient has all the symptoms of 
anaemia and leucocythaemia; is very weak, looses flesh, and suf- 
fers from great exhaustion on the slightest exertion. The white 
corpuscles in blood is greatly increased; tightness or constric- 
tion of chest and abdomen; progressive increasing debility. 

The Diagnosis and Pathology of this disease is easy — a pro- 
gressive enlargement of the lymphatic glands, especially of the 
neck and groin, and at the same time the spleen is much en- 
larged, and contains some deposit, chiefly embryonic tubercle. 
These glands, when cut into, are uniform in structure, trans- 
lucent and tough, and usually consist of a combination of 
germs, tubercular, syphilis, or cancer, one or all, the contents 
appearing to the naked eye as albuminous or lardaceous matter, 
and precisely the same in the spleen, messentery and pink mar- 
row. It is this blocking up of those blood-raising glands that 
gives us the extreme anaemia, dropsy, exhaustion and death. 
In all cases, tubercle is present, whether the syphilitic or cancer 
germ be present or not. 

No better criterion, or gauge, or index can be given of the 
intensity of germ-disease — the degraded living matter of our 
own bodies — than the enlargement of the lymphatic system, 
their engorgement, or blocking up, with disease-germs. 

Treatment. — Alteratives and tonics, the most nourishing 
food, sea air, change of scene. 

INFLAMMATION OF LYMPHATIC GLANDS. 

The lymph canals or channels are liable to take on inflam- 
mation from a great variety of causes, chiefly, however, due to 
diseased germs in the blood, or to local, or reflex irritation, so 
that we have simple adenitis from irritation, as walking, exercise, 



438 DISEASES OF THE LYMPHATIC SYSTEM. 

ingrowing toe-nail; adenitis, due to tubercle, syphilis, cancer, 
etc., etc. Most commonly met with about neck, axillae, groin. 
It may be acute or chronic. 

Symptoms. — In the acute form there is languor, lassitude, 
debility, rigors, and a fever, and the affected glands become 
hot, swollen, hard, tender, and very painful. As the swelling 
increases in size there is usually redness or lividity over the 
part. If the convoluted tubes become obstructed the surround- 
ing tissues swell. Unless resolution occur, or acute stage sub- 
side into chronic, there will be rigors, pain change to a throb- 
bing, and the gland will suppurate. 

In the chronic form there is no fever, nor much local pain 
or heat, but induration, with persistent enlargement. The 
adjacent tissues are not much involved, so that the gland is 
movable. In true syphilitic, or cancerous adenitis, gland sel- 
dom suppurates. The tubercular form is most common about 
neck or arm-pit, and is invariably chronic ; most common in 
children and young ladies. There are rarely any other symp- 
toms but progressive enlargement of a chain of glands, which 
become filled up with tubercular germs, which are at first 
albuminous, then milky ; by and by cheesy, and latterly, calca- 
reous. In either of the stages glands may remain stationary 
for a long time, and gradually ulceration of gland, cellular 
tissue and skin takes place, and its contents escapes. There are 
usually several of them, and they form a union by sinuses 
underneath the skin, and communicate. As a rule, when sup- 
puration does take place, there is slight rigors, fever, restless- 
ness, irritability, tongue coats, bowels constipate, appetite fails, 
urine scanty, and loaded with urates. When the tubercular 
diathesis is very strong there may be a general degeneration 
of the glands, and great impairment of the general health. 
When the lymph canals of the mesentery are irritated, in 
diarrhoea of tubercular children, we have the remarkable dis- 
ease, tabes mesenterica. 

Treatment. — In all cases control fever with aconite and 
serpentaria. Open bowels with cascara or other mild laxatives. 
Administer tonics, as cinchona, golden seal, before meals, and 
alteratives two hours after eating, as compound syrup Phy- 
tolacca ozonized, glycerite of ozone, ozone-water, iodide potass, 
with daily baths, flannel clothing, exercise in open air, and 
the very best of food. To the glands, try first ozonized clay, 
which is our best stimulant and discutient. That failing, 
stramonium or belladonna ointment, with iodide of potass; 
iodoform ointment twent}^ to forty grains to ounce of cerate ; 
idide of lead ointment. 



DISEASES OF THE URINARY ORGANS. 439 



DISEASES OF THE URINARY ORGANS. 



Acute Inflammation of the Kidneys. — Inflammation of the 
Substance of the Kidneys, or Acute Nephritis, is a comparatively 
rare affection. 

It is predisposed to by debility, or a tubercular diathesis, 
poor living, mental depression. Its exciting causes are cold, 
damp, exposure to vicissitudes of weather, mechanical injuries, 
lifting, hoisting, strains, blows ; to the presence of calculi or 
gravel in the kidne} r s ; excessive beer or whisky drinking ; the 
drastic action of such drugs as turpentine, balsam copaiba, can- 
tharides, and it is also caused by diseased germs. 

Symptoms. — In addition to the usual symptoms of languor, 
lassitude, debility, there is great constitutional disturbance, 
headache, pain in back and legs, rigors, fever, nausea, vomiting, 
hard, frequent, but small, wiry pulse, constipation, and a local- 
ized pain over the region of the kidneys, increased by pressure 
and movement ; pain is permanent and severe and often ex- 
tends down the ureter to the bladder, groin, scrotum, or testi- 
cle ; besides, there is numbness of the anterior portion of thighs, 
retraction of the testicle and tympanitis ; frequent micturi- 
tion, a desire to void water when there is none in the bladder, 
or passed in drops; often suppression of urine, and if there is 
any passed it is very high colored and contains casts of the 
kidney tubes, or blood in large or small amount, or pus. If 
the urine is suppressed there will be uraemia, with coma or 
convulsions. If recovery follow it is liable to leave the kidneys 
weak for some time. Besides resolution or recovery, the case 
may terminate in a violent attack of haematuria, and get well; 
or, in effusion of lymph and abscess of variable sizes, which are 
very destructive to the body of the kidney. 

These abscesses are likely to lead to ulceration, perforation of 
capsules, and renal fistula, and establishment of a muco-puru- 
lent discharge ; often fatal hectic associated with those abscesses. 
In favorable cases the pus is evacuated, the kidney heals up, 
and a good cure takes place. Besides being a result of inflam- 
mation, abscess may be due to the presence of a stone in the 
kiduey, obstructing and irritating the passages. 

Treatment. — If seen early, administer an emetic; follow 
with aperient and enemata and alcoholic vapor bath ; then put 
patient to bed, between blankets; apply mustard sinapisms 



440 DISEASES OF THE URINARY ORGANS. 

over kidneys and over stomach ; when a very decided redness 
is produced, hot linseed poultices; disturb patient as little as 
possible in their application. Administer aconite, tincture of 
green root gelsemium and digitalis, in small doses, frequently 
repeated till pulse reaches 60; then, at longer intervals. Those 
three arterial sedatives operate well, and should be given for 
some time in smaller doses, at longer intervals. If there is 
the slightest tendency to ursemic symptoms, hypodermic injec- 
tions of one-third of a grain of pilocarpin. Low diet, milk and 
lime-water, beef-tea. No drink, nothing to give kidneys work. 
If case progresses favorably, apply irritating plaster over kid- 
neys, and administer either quinine, with aromatic sulphuric 
acids, or compound tincture of cinchona with nitromuriatic 
acid. For two or three months patient should use, three times 
a day, either an infusion of buchu, or uva ursa, or queen of 
meadow, or pipsissewa, or cleavers, or pareira brava, to restore 
tone to kidneys. 

ACUTE BESftUAMATIVE NEPHRITIS. 

Tubular nephritis, or acute albuminous nephritis, is an affec- 
tion of the kidne} r s, greatly on the increase, and forms what is 
known as acute Bright's disease. Its chief characteristics are 
excessive proliferation of the convoluted tubes of the kidneys, 
with congestion of the malpighian tufts, an exfoliation of the 
walls, and the white blood escapes. The shedding, or shelling, 
or peeling of the tubes in the process of proliferation, by which 
they lose their epithelial lining, chokes up the tubes, obstructs 
secretion. The morbid process is tubular, interlobular, inter- 
stitial, commencing at the surface, and proceeding inwards, 
leaving the cortex pale. In this process the walls of vessels 
usually give way, and the serum and white corpuscles mingle 
with the urine, rendering it albuminous, the fibrin coagulates 
in the tubes, and forms casts. The malpighian bodies form 
bright red points, pyramids, dark and congested; kidneys much 
enlarged. 

Causes. — Privation, exposure to wet or cold, but especially 
when the nerves of the kidney are weakened, and there is a 
union of the urate of soda with lithic acid from beer or ale- 
. drinking, and especially the germs of scarlatina. 

Symptoms. — There is a sudden seizure of chilliness, rigors, 
fever, with headache, thirst, vomiting, restlessness, with pain 
and tenderness over region of the kidneys; frequent micturi- 
tion; urine scanty; of a dark, smoky color, persistent and highly 
albuminous, with abundance of fibrinous casts, epithelial casts, 
renal epithelium, blood casts, and few blood corpuscles; dropsy 
of the cellular tissue, general oedema, face puffy, hand swells 
if it hangs down; dropsy and anaemia; a strong tendency to 



DISEASES OF THE URINARY ORGANS. 441 

effusion of serum from membranes of brain, peritoneal coat, 
pleura. 

There are cases occasionally met with of general dropsy and 
albumenuria, without a desquamation or peeling off of the renal 
epithelium, called won-desquamative disease of the kidneys. 
This is apt to occur in bad cases of blood-poisoning, owing to 
a failure of vital power to eliminate morbid material from the 
system. 

A favorable sign is free and copious urination without albu- 
men ; an unfavorable indication is scanty, or total suppression 
of urine, aggravated dropsy and effusion into the serous cavities, 
pleura, pericardium, and peritonaeum. 

Treatment. — If the result of intemperance, active measures, 
as cupping over the kidneys; open bowels quickly with elaterium ; 
alcoholic vapor bath; then put to bed between blankets; mus- 
tard, followed by hot poultices over kidneys ; very free diapho- 
resis, with jaborandi or pilocarpin ; try first infusion of digitalis 
and nitrate of potass ; and if that fail, citrate of potassa in infu- 
sion of haircap moss, and general treatment as laid down under 
Bright's Disease. 

In the little child, whose kidney tubes are peeling off and 
exfoliating, our treatment must be more gentle, and still effi- 
cient,but different from the above — warm baths ; confinement to 
bed; dry heat to kidneys, in the form of chamomile flowers or 
bran in a bag, heated in an oven ; to lie between blankets, and 
give most nutritious diet of beef-tea, milk, eggs, etc. Try infu- 
sion of digitalis and sweet spirits of nitre, in alternation with 
quinine and aromatic sulphuric acid. Open bowels with com- 
pound licorice powder. The infusion of digitalis is our best 
remedy ; but if it fail, try infusion of asparagus-tops and nitrate 
of potassa, or infusion of parsley-root and citrate of potass. Per- 
severe with the quinine and aromatic sulphuric acid. If those 
remedies do not avail, then try nitroglycerine — a two per cent, 
solution, in one-drop doses, every four hours. Most excellent 
results have followed the use of the remedy in this form of 
acute interstitial nephritis ; it relieves every symptom, the op- 
pression, the vascular tension ; the kidneys resume work, peel- 
ing is arrested, and we are soon gratified with a copious secre- 
tion of urine free from albumen and tube casts. There are no 
cases but what are relieved, if not cured, by the action of this 
drug. Improvement inevitably follows. 

BRIGHT'S DISEASE, 

Or Chronic Desquamative Nephritis, or Contracted Granular 
Kidney, or Gouty Kidney, is a true interstitial degeneration, or 
breaking-down of the epithelium of the convoluted tubes ; an 
exfoliation, or shedding, or peeling of the walls of vessels, which 



442 DISEASES OF THE URINARY ORGANS. 

lose their epithelial lining. They collapse, become filled up with 
broken-down debris or rubbish ; choke up the tubes, and obstruct 
secretion. This interlobular death causes them to contract. 
Nature makes efforts at revival again and again ; but this shed- 
ding of renal epithelium continues ; and besides blocking up 
the kidney, appears in the urine in a more or less disintegrated 
form. The tubes lose their lining altogether, and either col- 
lapse or become filled up. This denuding process permits the 
liquor sanguinis, or serum, or albumen of the blood, to escape 
in the urine, so that the urine is persistently albuminous, of low 
specific gravity, and contains granular casts and epithelium. 

Causes. — Impaired vital force, such as we find in tubercular 
and other states, in which nerve centres are feeble, may be a 
predisposing cause ; but diseased germs, like m alaria, the bacteria 
of erysipelas ; the vibrios of typhoid fever; the amoeba of catarrh; 
the oidiurn albicans of diphtheria, germs of syphilis, and of other 
diseases, are exciting causes. Besides, in the left kidney, which 
is so freely covered with the sympathetic nerve, it may arise 
from mental exhaustion, or over-work, or worry, or struggle 
for existence. The indiscriminate use of such drugs as mercury, 
balsam copaiba, turpentine, cantharides, juniper berries, acetate 
of potassa, etc., often give rise to it. Bad living, constant expo- 
sure to wet and cold, to atmospheric changes, deleterious trades, 
and intemperance, are common causes. Out of every one hun- 
dred persons who indulge in beer and other alcoholic com- 
pounds, and thus lay the elements of gout and rheumatism in 
their blood, eighty per cent, are affected, more or less, with des- 
quamative nephritis. The union, therefore, of the urate of soda, 
with lithic acid in a weakened kidney, or in gout, is the most 
common of all causes. In this enumeration, previous disease, 
blows, lifts, strains, etc., are not to be overlooked. 

Symptoms. — As it is essentially chronic, it may exist in a mild 
form for many years without even being suspected ; patient com- 
plaining of little or nothing but debility ; but it moves on until 
this weakness becomes associated with loss of flesh, languor, lassi- 
tude, health gradually fails, insidiously and slowly, there are 
indications of giddiness or vertigo ; specks or spots before the 
eyes ; noises in the ears ; skin, when closely inspected, has a 
uriniferous look, and even smell; the conjunctiva has a pearly 
whiteness ; tongue large, flabby, with longitudinal fissures or 
kindey-tracts ; pulse feeble, extremities cold. No pain, usually, 
over region of kidneys; sometimes a sense of weight or weak- 
ness. Urine is free and copious, very pale, of a very low den- 
sity, but persistently exhibits traces of albumen in large or small 
amounts ; but it is loaded with epithelial casts and epithelium. 
Diseased action progresses onward ; the above symptoms become 
aggravated in degree and in intensity ; then dropsical symp- 



DISEASES OF THE URINARY ORGANS. 443 

toms appear; oedema of the ankle and feet, or puffing under 
the eyes, and anasarca and dropsy of one or more of the serous 
cavities ; and by-and-by, with symptoms all the time growing 
worse, degeneration of the kidneys appear ; or structural changes 
in the form of fatty or amyloid usurpation. The blood becomes 
very impure, loaded with urea ; there is an innate or inherent 
power of resistance to the circulation of contaminated and deter- 
orated blood throughout the vessels whence arises the high 
tension in arteries; hyperthropy of the muscular coat of the 
arterioles, and enlargement of heart; often organic disease, 
especially valvular. This impure blood acts badly on the nerve 
centres ; retinitis, and other signs of degeneration often appear. 

The symptoms can be arranged under three heads. 1. Con- 
gestion of kidneys. 2. Obstruction and dropsy. 3. Degenera- 
tion. Through each the persistent presence of albumen in the 
urine is the leading feature with kidney casts. The anaemia, the 
uriniferous aspect and dropsy are more decided in second stage, 
and in the third, uraemia, from utter failure of the kidneys to 
eliminate urea, which poisons the brain and cord, and thus 
causes death ; or haemorrhage may take place into the brain, 
or some accidental condition may occur to cause death, as 
inflammation of lungs, heart, etc. 

In explaining this high tension of arteries in Bright's disease, 
we must look at the grave changes that are going on. The 
changes in the kidney are interstitial death, or a breaking clown ; 
the broken-down debris causes compression and contraction of 
the nephritic cell, infiltration of its interlobular stroma. This 
falling in, or contraction of the capillary loops, causes them to 
be emptied ; and being compressed, are rendered functionally 
useless. They either undergo simple atrophy, and become im- 
pervious; or are affected by degeneration, and converted into 
granular masses, which appear like gelatine. A rise in the 
blood pressure must necessarily follow, which acts directly in 
increasing the albuminous urine. 

There are several factors that serve to determine a rise in the 
blood pressure during the stage of cell transformation and 
shrinking of the kidney. These are destruction of the capillaries, 
changes in the vessels themselves, in thickening of their walls, 
and degeneration of the kidney. Attempts at compensation 
are also innitiated : the walls of the renal vessels, whose coats 
have undergone least alteration, become abnormally permeable, 
and thus permit the exudation of albuminous matter. There 
is also a perfect anastomosing of vessels of the kidney with the 
suprarenal and lumbar vessels. Thus a portion of the blood 
which should pass through the kidney, if healthy, is diverted, 
as it were, into other channels, by the locked flood-gates, and the 
stress of it thrown back upon the heart, so that the heart begins 



444 DISEASES OF THE URINARY ORGANS. 

to hypertrophy, in order to overcome the condition of obstruc- 
tion. When hypertrophy is once established, it aids in over- 
coming the difficulty. 

In the first stage, or interstitial cell infiltration, albumen in 
the urine is present in small quantities ; whereas, in the second 
stage or cell transformation and contraction, it becomes abun- 
dant. 

General Treatment. — Our attention should first be directed 
to general management: The appetite must be promoted in every 
conceivable form, with tonics, and digestion aided with pepsin ; 
the most nutritious kind or quality of food recommended, as 
beef, mutton, game, poultry, boiled fish, eggs, milk, vegetables, 
and ripe fruit ; and specially forbid sugar, fat, starch, alcohol, 
or malt liquors. The diet is to be generous and nutritious to 
a fault. The bowels to be evacuated daily. The skin should 
be attended to, with daily sponging, or tepid bathing, and its 
general warmth promoted by flannel clothing and a warm room 
of 75° Fah. 

Over both kidneys, irritating plaster one week, ozonized clay 
the next, keeping up the rotation for six months after all traces 
of albumen and casts have disappeared. As it is a chronic dis- 
ease, alteratives should be used all through — ozonized Phyto- 
lacca, compound extiacts of stillingia, corydalis, etc., with 
■iodide of potass. These vegetable agents should be alter- 
nated with tonics, quinine, and mineral acids, bark, and acids, 
glycerite of ozone, ozone-water, etc. While pursuing the use 
of alteratives and tonics, change them once a week, so that the 
patient does not become habituated to any one drug. Besides 
adopting this general treatment, there must be a special course 
of remedies used to meet the three prominent indications : 

To Arrest or Check the Flow of Albumen. — Some of the follow- 
ing remedies should be selected and tried, say, for forty-eight 
hours ; and if no check, another substituted : Gallic acid, in 
fifteen-grain doses thrice daily, in a tablespoonful of port wine ; 
tincture or infusion of digitalis, ten drops of the former, or 
wineglassful of the latter, thrice daily ; iron in tincture, or iron- 
alum, oil of erigeron, ergot, matico, mineral acids. 

To Remove Effusion, or Dropsy of the Cellular Tissue: Infusion 
of digitalis, followed by diaphoretics, diuretics, and hydragogue 
cathartics. 

An infusion of digitalis, made fresh daily, as laid down, has 
a marked action on the brain, the heart, and arteries; it often 
arrests the escape of the albumen itself; it unlocks the absorbent 
system, and is a most serviceable drug. Many are, and have 
been, disappointed in its action, simply from inattention to its 
proper mode of infusion. It deserves a fair trial, properly 
prepared. 



DISEASES OF THE URINARY ORGANS. 445 

As to diaphoretics, let it be understood that diaphoresis relieves 
renal congestion. The alcoholic vapor bath thrice a week ; the 
use of that prince of diaphoretics, pilocarpin, about as often 
hypodermically, in one-third-grain doses'; external warmth. 

As to diuretics, they are of undoubted utility, but must be 
carefully guarded. To restore, by remedies, the natural func- 
tion of the kidneys, and wash out broken debris, we must restore 
the action of the kidneys, aid elimination, restore, if possible, 
the physiological process. Experience has demonstrated the 
utility of saline diuretics and digitalis in renal disease — such 
as cream of tartar, and nitrate potass, do not increase, but dimin- 
ish the amount of albumen in the urine ; they are to be pre- 
ferred to other remedies ; the obstructed tubuli uriniferi need 
flushing, and we must bring diuretics to the work. 

As to hydragogue cathartics, or active purgatives, never to 
weaken strength, but to cause a quasi vicarious elimination of 
carbonate of ammonia from the alimentary canal, are of great 
efficacy, and tend to prolong life. 

If successful in causing the disappearance of albumen and 
getting rid of dropsical effusions, the patient still on alteratives 
and tonics, the use of what are termed astringent diuretics should 
be commenced. These embrace such as buchu, uva ursi, pareira 
brava, queen of the meadow, cleavers, pipsissewa. 

One of these selected, used for a few days, then another, select- 
ing the two from which most benefit is derived, and adminis- 
tering alternately week about. These should be given in the 
form of infusion, and taken freely, as they have a very vital- 
izing action on the kidneys. Infused over night, and allowed 
to cool ; made fresh every twenty-four hours. Any special dis- 
ease, occurring during the progress of treatment, should be 
attended to. If the patient has been intemperate, or even 
slightly addicted to the use of malt liquors or whisky, there is 
the greatest tendency for the weakened kidney to take on fatty 
degeneration; if, however, he is merely tuberculous, the inhe- 
rent tendency is to amyloid degeneration; when either takes 
place, the kidney, which is small and contracted in Bright's 
disease from interstitial death and caving in, may now become 
enlarged and flabby. 

(1.) Fatty Degeneraiton. — Usually the result of desquama- 
tive nephritis, or Bright's disease. If it occurs without the 
precursory disease, intemperance and bad living may bring it 
about. Kidneys are usually large, pale, soft, doughy, andfatty. 

Symptoms. — A recapitulation of all the symptoms enumer- 
ated in Bright's disease, but greatly aggravated ; debility in- 
creases rapidly; the uriniferous aspect, palor, and anaemia much 
intensified; the pulse is now irritable and frequent; there is 
general oedema ; pufflness of face and hands ; frequent micturi- 



446 DISEASES OF THE URINARY ORGANS. 

tion ; dyspepsia, with attacks of vomiting ; a tendency to in- 
flammation of the membranes of brain, pleura, peritonaeum, 
pericardium, and amaurosis, due to albuminuria, retinitis, and 
degeneration ; anasarca of the limbs and dropsy of the cavities. 
Indications of ursemic poisoning show themselves often in con- 
vulsions, coma, etc. The urine in fatty degeneration from the 
very commencement exhibits oil-globules, is very scanty, low 
specific gravity, and highly albuminous. There are also cast- 
cells filled with oil, presenting the appearance of dark, opaque 
masses, besides the oil-globules. 

When the urine is highly albuminous and presents a large 
number of oil-casts and cells, the case is to be regarded as a 
serious one, as they indicate an intractable form of the malady. 

(2.) Amyloid Degeneration. — Waxy, or starchy, or amyloid 
degeneration, is liable to occur in tubercular subjects affected 
with Bright's disease. The usurpation of the kidney by this 
substance renders it inefficient as a secreting organ, and ulti- 
mately useless. Kidney here becomes large, heavy ; has a glis- 
tening appearance on section; turns blue or black color if 
touched with iodine and sulphuric acid. 

Symptoms. — Great debility, with all the symptoms of Bright's 
diseases; if anything more lassitude, prostration, thirst, and 
usually an excessive secretion of urine highly albuminous, pale 
in color, acid reaction, of low specific gravity. Delicate, trans- 
parent, waxy, or hyaline tube-casts are to be seen, which are 
formed by the coagulation of an exudation from bloodvessels 
into tubules denuded of epithelium. There is the peculiar uri- 
niferous odor and pallor of skin, eye, lips, and mouth. The 
urine decreases in quantity, but albumen increases. There is 
general oedema and anasarca; case progresses slowly but surely. 
Other organs, as the liver and spleen, become affected ; some- 
times deposits of starch on intestinal tract, which gives rise to 
diarrhoea, and waxy degeneration ; dropsy of chest and abdo- 
men ; uraemia, with intoxication, or convulsions terminate the 
case. 

Treatment. — When the case has reached the stage of degen- 
eration, either fatty or amyloid, the greatest possible attention 
should be paid to diet. Let it be nutritious, and exclude all 
carbonaceous articles. The alcoholic vapor-bath every other 
day, and a free action of the bowels daily ; warm clothing, ex- 
ternal warmth in heated rooms. Over region of kindeys the 
ozonized clay operates very beneficially. A general course of 
vegetable alteratives and tonics, embracing specially ozonized 
compound phytolacca, glycerite of ozone, ozone-water, com- 
pound tincture cinchona and nitromuriatic acid, quinine, and 
aromatic sulphuric acid . 

A sea voyage of a few months is always attended with the 



DISEASES OF THE URINARY ORGANS. 447 

most salutary results. The following remedies are used with 
very beneficial results : 

Nitroglycerin. — A one per cent, solution, of the nitroglycerin, 
given in one minim doses every half hour till its physiological 
effects are produced, and then continued at regular intervals 
in three minim doses thrice daily, the urine will become normal, 
entirely free from albumen, oil-globules, and waxy casts, and 
this after the case has almost been deemed hopeless. Whatever 
may be the pathological condition, it is unquestionably relieved 
by the nitroglycerin, and improvement immediately follows. 

(3.) Cystic Degeneration. — There are usually four forms of 
degeneration met with in the kindey. Two of them follow as a 
natural sequel from Bright's disease : (1.) Cysts varying in size 
from a pin's-head to a hazel-nut are common, as a result of 
interstitial breaking down and obstruction. (2.) General cystic 
degeneration from atrophy and obstruction, and expansion or 
dilation of uriniferous tubes. (3.) Small cysts are often met 
with on the surface of the kidney, w T hich do not interfere with 
its function in any way. Sometimes they attain a great size, 
and form an appreciable abdominal tumor. (4.) Congenital 
cysts, complete or incomplete, or kidneys made up of cysts 
without any trace of secreting tissue ; usually combined with 
other malformations. 

If the result of chronic desquamative nephritis, treatment 
same as for degeneration. In the other forms the symptoms 
are often obscure. 

Uraemia. — Disease of the kindey, after going through its 
forms of inflammation and degeneration, has a tendency to 
terminate in ansemia, a form of blood poisoning due to the 
accumulation of urea in the blood, owing to the inability of the 
kidneys to eliminate. There are probably two forms of poison- 
ing, — one in which carbonate of ammonia is formed from the 
decomposed urea ; the other in which that decomposition does 
not occur. The anaemic condition of brain and spinal cord en- 
ables this poison to operate speedily in the production of irri- 
tation of the great nerve-centres, giving rise to coma, intoxi- 
cation, delirium, convulsions, preceded by impaired vision, 
obstinate vomiting, or diarrhoea. In iirsemic coma the tem- 
perature is low ; there is often twitching of muscles ; rarely 
stertor, and at first patient can be roused ; breath and skin has 
a uriniferous or ammoniacal odor. 

DROPSY OF THE KIDNEY. 

Hydronephrosis, or Distension of the Kidney by a Fluid. — May 
be congenital, or may result from obstruction of ureter by a 
calculi; or by tubercular or cancerous deposit, or from the 
presence of a tumor. The kidney is often converted into a 



448 DISEASES GF THE URINARY ORGANS. 

large pouch. It may be associated with suppuration of lining 
membrane of pelvis and calices. 

Symptoms. — If the other kidney is healthy and the disten- 
sion is not great, the symptoms may be obscure. In other 
cases, when large, the tumor may be felt in the loin, reaching 
forward in the abdomen, has an undulating or fluctuating feel 
to the touch, and it may or may not be tender. If only one is 
affected, quantity of urine may be natural; if both are impli- 
cated, there will be likely suppression, partial or complete. It 
may contain pus if there is a stone or associated pyelitis; com- 
plete suppression, uraemia; attacks of nephralgia or nephritic 
colic if there is a calculi. 

The treatment consists in rest, hot vapor-bath, poultices of 
lobelia and belladonna over loins, marsh mallow tea, and nitre, 
to force offending body forward. 

CANCER OF THE KIDNEY. 

The deposit or localization of the cancer-germ in the kidneys, 
is a rare affection. AVhen it does occur, it is usually on its 
cortical substance, and extends inwards, usurping the proper 
texture of the gland. 

In its very incipient stage it may be readily recognized by 
the cachexia, by the pain, anterior, and posterior. The growth 
of cancer-germs, when fully started, often becomes immense, so 
that they often attain an enormous size, filling up the abdominal 
cavity. The chief symptoms, besides the pain and diathesis, 
are the enlargement of the gland, hematuria, sickness, emaci- 
ation, anasarca. 

General treatment, but especially large doses of conium and 
opium, to relieve pain. A lotion of sulphate of manganese 
over the kidneys, with a liberal use of the ozonized extract of 
saxifraga. 

TUBERCLE OF THE KIDNEY. 

In very rare cases of persons affected with tubercle do we 
find a deposit in the kidney. When it does occur, it is very 
uncommon for it to be detected during life. Both kidneys are 
usually implicated, and it is generally the case when it occurs 
that the ureters and bladder are also involved. When the germ 
is active, large cavities are produced by them eating out the 
renal tissue. There is no pain, often hematuria, and pus, in 
large quantities, and tubercle, can be found copiously in urine. 
Besides, there are the general indications of tuberculosis, in 
addition to those of renal disease. 

If germs are not discharged it is likely to cause death by 
ansemia, uraemia, or ichorrhremia. 



DISEASES OF THE URINARY ORGANS. 449 

PARASITES IN THE KIDNEY. 

There are four varieties of entozoa that infest the human 
kidneys: 

(1.) Hydatids. — Sacs formed from condensation of surround- 
ing tissue, lined by a bladder or cyst, and filled with a limpid, 
salt fluid, floating in which are found numerous small bladders, 
which contain the entozoa known as the echinococcus, which 
is the immature tape-worm that infests the dog. These cysts 
are often discharged in the urine, and their passage produces 
symptoms like those caused by a calculus. Recovery may take 
place, or cysts may be discharged for years and years, and wear 
out vital force by irritation, inflammation, and suppuration. 

(2.) Distoma Haematobium. — Endemic to the residents 
along the Mississippi, and giving rise to the hematuria of 
intermittent fever. 

(3.) Tetrastoma Renale — Infests the uriniferous tubes. 

(4.) Strongylas Gigas. — This is very rare. 

The larva of these different parasites find ingress to the body 
chiefly by water, and breed in this special part of the organism. 

Treatment. — Mineral acids and cinchona, glycerite of ozone, 
sulphuric acid. 

DIURESIS. 

A condition in which a quantity of pale, limpid, urine is 
secreted, free from sugar or other abnormal ingredient; the 
amount is to be excessive to constitute the condition. The term 
Polyuria is applied to it, provided the large quantity contain 
an absolute and relative increase of urea. 

The cause is some reflected nervous irritation, like hysteria 
or hypersemia. 

Symptoms. — Are insatiable thirst, with excretion of large 
quantity of urine. The watery constituents are increased 
excessively, and specific gravity is low. General health suffers ; 
the excessive thirst and frequent micturition cause bad nights. 
Dropsy may set in if not relieved. 

In some cases there is an excess of urine over amount of 
liquids taken ; in that case, the body must waste and lose its 
water, or water is formed in the body by direct union of its 
elements — oxygen and hydrogen. 

Treatment. — General attention to the laws of life — diet, baths, 
clothing ; remove any source of nervous irritation. Then try 
nervines, such as glycerite of kephaline or ozone; fluid extract 
sumbul, scutillaria, nux vomica and cinchona, or valerian in 
tincture or phosphate of iron and valerianate of zinc. Under 
one or other of those nervines mental and bodily vigor rapidly 
improves. Unless this view of diuresis is accepted and followed 

41 



450 DISEASES OF THE URINARY ORGANS. 

up, our treatment will be unsatisfactory. The intense thirst 
and discomfort can only be relieved by toning up the nervous 
system. Drugs like valerian are highly efficacious — especially 
in the dual form of tincture and valerianate of zinc. 
Enforced abstinence from fluids useless. 

CHYLURIA. 

Chylous urine, or the excretion of urine of a milky appear- 
ance from the presence of fatty matter in a molecular state. 
In addition, there is generally present liquor sanguinis, blood- 
corpuscles, fibrin, and albumen. The urine, after standing a 
little while, coagulates into a trembling mass resembling com- 
mon size or blanc mange. Common in tropical latitudes, and 
is associated, not always, but in many instances, with the nlaria 
in the blood. 

Associated with this condition of the urine there is great 
lassitude and debility ; pains about loins and stomach ; very 
great mental anxiety ; loss of flesh. It is usually intermittent 
in its nature ; chylous for months ; healthy for same space of 
time, and then recur on and on. 

Treatment. — Sea air, salt-water baths, very nourishing diet ; 
flannel roller over abdomen ; compound tincture cinchona and 
mineral acids; quinine and aromatic sulphuric acid, and gen- 
eral tonics and alteratives. 

HEMATURIA. 

Bloody urine, or haemorrhage from the mucous membrane 
of the urinary passages, the kidneys, bladder, urethra. 

Causes. — It may be a symptom of acute inflammation of the 
kidneys ; or arise from the germs of malaria, causing irritation 
or morbid states of the blood ; strains, blows, stone in, or 
cancer of, the kidney, etc. 

Symptoms. — Urine smoky, or of a port wine tint ; albumen 
present. When from the kidney, it is generally diffused through 
the urine ; when from bladder or urethra, blood comes away 
after passing clear urine. Blood-casts of renal tubes, cancer- 
cells, or renal calculi. 

Hematuria very often present in Southern ague; it may 
occur paroxysm ally with the fit. 

Strong liability to hematuria in purpura, scurvy, or white 
cell-blood ; comes on from the slightest cold or exertion ; also 
a symptom in bilious, remittent, and yellow fevers; and in or 
among the inhabitants of those localities where such prevail, it 
is endemic. 

Treatment. — This will depend on cause. If due to some 
diathesis, or ague, quinine and mineral acids ; if due to inflam- 
mation, digitalis and gelsemium ; if due to scurvy or purpura, 



DISEASES OF THE URINARY ORGANS. 451 

mineral acids, cinchona, and digitalis; if no cause can be 
assigned, styptics, as gallic acid, or perchloride of iron, or 
ergotin, or infusion of matico, followed with one or other of the 
astringent diuretics, as buchu or uva ursi; but in all cases insist 
upon absolute rest in recumbent posture in bed, with dry heat 
over kidneys ; or mustard, followed by irritating plasters, with 
active state of bowels and skin. 

If from the bladder, the sulphuric acid turpentine mixture 
is invaluable, with hot poultices ; in mild cases, gallic acid and 
astringent diruetics, as pipsin. 

If from the urethra, large doses of green root tincture gelse- 
mium, and camphor; the local application of cold. 

RED GRAVEL, OR URIC ACID DIATHESIS. 

In health the urine is very slightly acid, but very nearly 
neutral; but when there is disease, when the co-ordinating 
chemical centre is damaged or weakened, there is a perversion 
in nutrition, and the urine will be found acid. The acid dia- 
thesis, then, is a state in which the nerve-centres are impaired, 
and the starchy or saccharine elements of the food are changed 
into uric acid instead of fulfilling the purposes of nutrition. 

Causes. — The causes that act upon the co-ordinating chemi- 
cal centre in producing this faulty condition of digestion and 
assimilation are numerous, as monotony of life, isolation, soli- 
tary confinement, sameness of diet and habits ; mucous dyspep- 
sia, disease of the liver, and pancreas ; imperfect aeration of 
blood by skin and lungs ; rapid oxydation of the fibrin of the 
blood, as we have in fever and inflammation ; excessive muscu- 
lar exercise ; the lactic acid of rheumatism is changed for the 
purpose of elimination into uric acid. 

Symptoms. — It is to be recognized by the persistent and more 
or less copious deposit in the urine of a brick-dust sediment; it 
may be only a few grains, and in some cases it is quite consid- 
erable. In mild cases, it may not appear till urine has cooled ; 
in more severe forms, it is deposited at once. There is always 
associated with it depression of the nervous system, in some cases 
amounting to prostration; undefined sensations of irritation in 
the loins ; sometimes excruciating pain in the kidneys ; nausea, 
vomiting, aching in the thighs; retraction of the testicles; 
irritation of ovar}^ ; itching at the orifice of the urethra ; irri- 
table bladder, with continence or incontinence of urine. The 
passage of the urine causes a burning or smarting sensation ; 
and when the uric acid crystals are large, a cutting, tearing 
sensation, as if particles of glass were being passed, with bear- 
ing-down and prostration. 

Treatment. — Special attention should be made to give the 
patient immediate relief, and this can only be done by the 



452 DISEASES OF THE URINARY ORGANS. 

administration of alkalies, a class of remedies whose use is 
likely to be detrimental if administered for any length of time ; 
still, for a few days, they had better be given, say, five or ten 
grains of bicarbonate of potassa thrice daily. While thus afford- 
ing temporary relief, proceed to the removal of cause, — sameness, 
monotony, isolation ; inculcate change of habits, diet, of every- 
thing that savors of sameness or monotony, for a high grade of 
mental and physical existence can only be attained by change. 
The essential elements of life is incessant change ; and in order 
that the highest state of existence may be procured, this must 
be attained. The make-up of the tissues of the body exhibits 
that fact; the fresher they are, the more complete their change ; 
provided construction exceeds destruction, the more serviceable 
they are. The secretions are to be regulated; daily tepid alka- 
line bathing ; flannel clothing ; moderate exercise in the open 
air ; diet is to be variable but nutritious, rigidly forbidding fat, 
malt and spiritous liquors, sugar, or starchy agents. 

In the medical treatment, vegetable alteratives and tonics are 
always of the greatest efficacy. 

Discontinue the alkali, and substitute benzoic acid in ten- 
grain doses, with same amount of borax, for the purpose of 
changing the uric acid into a non-irritating agent in the body. 
If for some cause it is not thought best to give the benzoic, 
substitute the salicylate of soda, which is a remedy of the 
greatest efficacy. This remedy has the effect of improving or 
restoring the tone of the co-ordinating chemical centre, and 
preventing the formation of the acid, and also of chemically 
causing its disintegration. 

Sulphate and phosphate of quinia are also valuable, but 
possess none of the chemical properties of the salicylates. 

Besides the above, a course of alteratives and tonics for a few 
months, embracing compound extract saxifraga, ozone-water, 
glycerite of ozone, and kephaline. 

WHITE GRAVEL, OR THE PHOSPHATIC 
DIATHESIS. 

This is a cachexia in which the urine is persistently loaded 
with phosphates and chlorides, which are deposited in the form 
of a floury mass, or white, gritty substance, calcareous in its 
character, called white gravel. The urine may or may not be 
alkaline. 

When human urine becomes alkaline, it is due to one or 
other of the following conditions : To excess of the alkaline 
carbonates of potassa and soda, which is apt to occur after a 
meal, especially of fruit and vegetables; to excessive elimina- 
tion of the phosphates, as in brain and bone waste ; to the 
formation of ammonia in the urine from decomposition of urea. 



DISEASES OF THE URINARY ORGANS. 453 

The reaction of the healthy urine in the twenty-four hours 
is slightly acid; but if separate samples are taken at different 
intervals, great variation is observed ; and these are constant. 
The acid reaction increases and diminishes, commonly, "with the 
secretion of gastric juice, — acid before a meal, alkaline after 
and during digestion. This is called the alkaline tide, and may 
be caused by the entering of newly-digested products into the 
blood, or a preponderance of alkaline bases in articles of diet. 

There is another channel by which acid is withdrawn from 
the blood besides the gastric juice secretion, and that is by the 
lungs. The exhalation of carbonic acid gas by the lungs is 
increased by food and the conscious state, and diminished by 
fasting and sleep. 

The urine need not, however, be alkaline, in the phosphatic 
diathesis; it is sufficient, in order to constitute this condition, 
that there be an excessive elimination of brain elements, that 
it be loaded with phosphates, the metamorphosis of such tissue. 

Causes, — Cerebral exhaustion, shattered nervous system, 
nervous disease, nervous dyspepsia, chronic disease, irritation 
transmitted, study, worry, gout, sexual excesses, etc. 

Symptoms. — The general indications are those of an intense 
nervous temperament ; white skin ; sharp features ; emaciation ; 
some chronic or nervous disease. There is no pain or irritation 
whatever; hence it is often unobserved by the patient ; so there 
are few symptoms but the amount of gravel present in the urine 
each twenty-four hours, which, grain for grain, represents so 
much waste of brain-tissue, just as the uric acid represents fibrin, 
muscle, etc. If the alkaline condition be present, it is due to 
two causes : either from the presence of the carbonate of a fixed 
alkali (potash or soda), or of the alkaline phosphate of sodium; 
or from the presence of the carbonate of the volatile alkali, 
ammonia, which is due to the decomposition of urea. 

The white gravel that is deposited in the last, the decompo- 
sition of urea, is formed as follows : Healthy urine contains 
phosphate of magnesium in a state of solution ; if the urine 
becomes alkaline from decomposition of urea, a portion of the 
ammonia combines with the phosphate of magnesium and forms 
a triple salt, which is insoluble in the urine. This triple phos- 
phate is usually an admixture of phosphate of lime. Urine of 
this kind, being allowed to settle, a scum forms on its surface, 
which, under the microscope, resembles the salts we have de- 
scribed. But the urine may become alkaline from the presence 
of the carbonate of potassa or soda, and then, no ammonia 
being present, instead of the triple salt, there is a deposit of 
amorphous phosphate of lime. In these cases the urine is 
generally alkaline, pale, copious, slightly turbid, of a low spe- 
cific gravity, and of a peculiar odor. 



454 DISEASES OF THE URINARY ORGANS. 

Treatment. — Generous diet; daily bathing; flannel cloth- 
ing; well-regulated secretions; the treatment of the morbid 
condition upon which it depends, and a resort to general altera- 
tives and tonics. 

OXALIC ACID DIATHESIS— OXALURIA. 

When the co ordinating chemical centre is further enfeebled 
by some nervous disease, alloxan is formed in sufficient quan- 
tity to combine with glycogen and prevent the formation of 
other substances; oxalic acid is formed, and appears in the 
urine. Now, this diathesis is dependent upon very great ner- 
vous prostration, especially in the nerve-centre and nerves that 
supply the lungs, stomach, pancreas, and liver. Generally 
found in old cases of chronic bronchitis or nervous dyspepsia, 
and is characterized by the persistent appearance of crystals of 
oxale of lime in the urine. 

Rhubarb may cause a temporary appearance of oxalic acid, 
which disappears as this vegetable is discarded or discontinued. 

The crystals appear in the form of minute, transparent octa- 
hedra, or like dumb-bells. 

The persistent presence of oxalic acid in the urine, indicates 
the very low state of vital power, and is very liable to give rise 
to two distinct and dangerous complications : 

(1.) A concretion of oxalate of lime (mulberry calculus) may 
form, either in the kindey, bladder, or prostate. 

(2.) The poisonous action of oxalic acid in the blood is liable 
to produce irreparable lesions in the brain, heart, stomach, etc. 

Treatment. — Great attention should be paid to diet. It 
should be generous, consisting of animal food, eggs, fish, milk, 
etc. ; all articles that contain oxalic acid, as rhubarb, sorrel, 
tomatoes, sugar, etc., be forbidden ; daily shower-baths, followed 
by friction ; flannel clothing. Vegetable alteratives and tonics 
should be administered. Our best tonics are iron, cinchona, 
hydrastis; muriatic acid in compound tincture cinchona is 
invaluable. 

The above three states are what is understood when we use 
the term " gravel," being the passage of one or other of those 
three bodies in the form of a gritty powder, or sand-like bodies, 
or small calculi, occasioning pain, irritation of kidneys, ureters, 
bladder, and urethra. 

Of those three principal forms, the uric acid is present in 
about eighty per cent, of all cases, and gives rise to more irrita- 
tion than either of the other two forms. All ages and both 
sexes are liable to be affected. They often give rise to neph- 
ralgia or neuralgia of the kidneys. 

In order to relieve this condition promptly, hot baths, hip- 
baths, hot fomentations to loins ; open bowels with salines, and 



DISEASES OF THE URINARY ORGANS. 455 

administer copious drinks of linseed tea, or infusion of marsh 
mallow, with alkaline diuretics, as nitrate of potassa in cider, 
or lemonade of cream of tartar. 

NEPHRALGIA OR NEURALGIA OF KIDNEY. 

Often due to gravel, or disease-germs, like malaria ; to drugs ; 
to suppression of an eruption ; in the left kidney to poisons of 
rheumatism ; gout, cold, wet. 

It is attended with most excruciating suffering; sharp 
lancinating pains, coming on suddenly, violent in intensity, 
relieved by pressure, never aggravated by it. If due to gravel, 
it may be continuous, beginning at the time it commenced to 
pass into the ureters, and continuing till it reached the bladder. 
The pain is paroxysmal in its character, not only experienced 
in the loins, but extends to the groin, thigh, or abdomen, caus- 
ing retraction of the testicle in the male, and irritation of ovary 
in the female. If the paroxysms are severe, they may be accom- 
panied with nausea and vomiting; a small, wiry, feeble pulse; 
profuse perspiration ; prostration, with a desire to pass urine, and 
an inability to do so. When concretion, if due to that, reaches 
the bladder, pain suddenly ceases ; if due to other causes, it may 
continue till the cause is removed. Its location, (relieved by 
pressure), character of pain being paroxysmal, with other symp- 
toms of kidney irritation, are always important land-marks. 

In the treatment, alcoholic vapor-bath ; external warmth over 
kidneys ; if stomach is so irritable as to cause everything to be 
rejected, apply mustard over it, and give a large dose of tinc- 
ture of green root of gelsemium ; if vomiting still persists, hypo- 
dermic injection of morphia, preceded by the inhalation of a 
few drops of chloroform. Then apply belladonna plaster over 
kidneys, and depend on quinine and gelsemium internally. In 
some cases aconite and belladonna answer well, with dry cups 
and lobelia fomentations. If due to the retrocession of an erup- 
tion, compound tincture serpentaria or jaborandi ; if due to 
rheumatism, alkalies, as nitrate of potasca and cream of tartar. 
Each case managed as to its cause. 

RED AND WHITE GRAVEL IN CHILDREN. 

Gravel, or ultimately, stone in the bladder and kidneys of children, 
is far from uncommon ; less frequent in the kidney in child- 
hood than in advanced life. The passage of a red, sandy sub- 
stance, or uric acid, from the bladder of children, is common, and 
too little attention is paid to it. It is very likely to occur if the 
little one eats to excess of any kind of food, animal or vegeta- 
ble, but more especially farinaceous and saccharine ; or if not 
regularly bathed, or does not receive a sufficient quantity of 
pure air. Besides, tubercular or gouty children have a much 



456 DISEASES GF THE URINARY ORGANS. 

greater tendency to it than others, irrespective of excess or 
unwholesome diet; and those who are kept in-doors, under a 
monotonous state, cold, damp, and influences that interfere 
with assimilation, as fear, grief, depressing passion, fatigue, 
febrile states. 

The uric acid may just be enough to stain linen, or it may 
be a copious brick-dust sediment, in crystalline particles. In 
infants and young children there is a special tendency to the 
formation of uric acid deposits, and these are often thrown down 
in the kidney before the urine has passed into the bladder. 
The so-called uric acid infarctions of the the kidney are often 
found after death in mere babes. These infarctions consist of 
urate of ammonia mixed with crystals of uric acid, and occupy 
the straight tubes of the pyramids of the kidney. In addition 
to the causes enumerated, the excessive feeding of young babies, 
and to the use of starch, which should be shunned as a poison, 
there is in the young that excessive metamorphosis of tissue in 
their bodies which is great in digestion, respiration, and heat 
formation, so that they are peculiarly liable to deposits in any 
part of the urinary apparatus, in the kidneys and bladder ; 
and once a deposit takes place, it is liable to become enlarged 
by successive additions or aggregations to the original point. 
Great irritation is often caused, and much untold suffering to 
the little one, by the presence and passage of those minute 
crystalline bodies, which are sharp like glass crystals, and cut 
and scratch the delicate lining of the kidneys, and even cause 
blood to appear in the urine, although the admixture of blood 
is comparatively rare. 

Besides the acid deposits, we meet with more rarely the limy 
or white gravel, which, in its passage, does not irritate, even 
though so copious as to render the urine thick, milky, and form 
concretions of the oxalate of lime, which, if small, are easily 
passed, because they are rounded off, but when the red gravel is 
passed the child screams and strains during its passage ; and if 
old enough, complains of pain in the back and urethra ; and the 
pain is so excruciating in some cases as to cause convulsions. 
When the red gravel is freely passed it is likely to be found on 
the infant's diaper, or in the form of red sand in the bottom of 
the chamber-pan. It is this form that gives rise to incontinence 
of urine, in the wetting of the bed at night. 

When these crystals are any size, and lodged in the kidney, 
there is likely to be blood in the urine. Hematuria in infants 
is generally due to this cause. Calculus often exists in babes 
without a single symptom to indicate it, until it passes by the 
ureter into the bladder. The frequency of uric acid concretions 
in the urine of children depends on their diet, bathing, and 
atmosphere ; if starch-fed, every one is affected. 



DISEASES OF THE URINARY ORGANS. 457 

The occasional appearance of uric acid in babies and children 
is always of importance, and should be looked after ; their food, 
and conditions under which they are living be attended to by 
a variation of diet ; no starch, nor sweets, nor cakes ; daily 
bathing, open air exercise; and dressed from head to foot in 
flannel or silk ; bed-room well ventilated, and never undressed 
only in a warm room. If, from the character of the urine and 
peevish irritability of the child, or actual distress in urination, 
a deposit is suspected, give citrate of potash and phosphate of 
soda, in sufficient doses to render the urine alkaline. Hydrangea 
should also be given ; and this treatment persevered with in 
the hope of dissolving the concretion, or reducing its size, so as 
to enable it, if in the kidney, to pass through the ureters ; if in 
the bladder, to pass by the urethra. 

If the child is a few years old, a more extended line of rem- 
edies should be resorted to : infusions of asparagus, or eating 
the cooked tops, if in season, are excellent ; uva ursi, nitric acid, 
and compound tincture cinchona; but as a general rule, the 
hydrangea is a sovereign remedy for the breaking-up of the 
stone, if it exists ; and if it can be persevered with there is the 
best hopes of success. 

URINARY CALCULI, OR STONE. 

These concretions are found in the kidneys, bladder, and fol- 
licles of the prostate gland ; when found in the ureters or ure- 
thra, they have floated there from the other parts. Calculous 
disease is much more common in males than in females, prob- 
ably owing to the anatomical character of urethra : in women, 
being short, from one and a quarter to two and a half inches 
long, and very dilatable ; whereas, in men, it is long, and not 
dilatable to any great extent. The cause is the uric acid, phos- 
phatic or oxalic acid diathesis ; so that these concretions are 
usually found to consist of uric acid, urate of ammonia, fusible 
calculus, (phosphate of lime, magnesia, and ammonia); mul- 
berry calculus, (oxalate of lime), carbonate of lime, and, very 
rare forms, cystic and xanthic oxydes. 

Calculi may consist of only one substance, or be made up of 
layers, of different salts ; they may vary in size from grains of 
sand-like bodies, to gritty gravel, up to the size of an orange ; 
once a nuclei being formed, they increase in size by aggregation. 

Small aggregations, or stones in the kidney, if not much 
larger than a kidney-bean, may pass from the pelvis of the 
kidney into the ureters, and thence into the bladder. The suf- 
fering which takes place in the transit of the stone is very great, 
and popularly known as an attack of gravel. As soon as cal- 
culus reaches the bladder, instant relief. 



458 DISEASES OF THE URINARY ORGANS. 

How to Diagnose a Stone in Kidney, and its Character. 

— There will be severe backache ; traces of pus in the urine. 
After exercise, especialty on horseback, bloody urine. There 
will likely, if stone is any size, be epithelium of the pelvis of 
the kidney, as well as blood corpuscles. The diathesis will 
guide us as to the kind of stone. But the nervous irritation is 
so great, in all cases, that if it begins as uric acid, it at once 
becomes phosphatic; the reflex nervous irritation creates that 
diathesis. Health suffers, loses strength and flesh. Stone 
gradually becomes larger ; excites snppuration ; fills up the 
body of kidneys, and renders them useless as secreting organs, 
and gives rise to uraemia. In addition to the above, there are 
the minor symptoms of kidney irritation ; itching at the orifice 
of urethra, aching in thighs, retraction of testicle. 

Passage of Stone into and through the Ureters— A patient 
suffering from the above symptoms has a sudden seizure of 
intense pain in the kidney, with nausea, vomiting, and great 
prostration ; a partial suppression of urine; symptoms increase ; 
pain moves down along the course of the ureters, and the 
moment stone drops into the bladder all iswell. In addition to 
the above, there may be all the indications of kidney irritation, 
and even hematuria. 

Indications of the Presence of a Stone in the Bladder. — 
Severe attacks of pain in the bladder, perinaBum, and at glans 
penis, either brought on or aggravated by exercise. Frequent 
micturition from the irritable bladder, or there may be conti- 
nence or incontinence of urine ; or even if patient can make 
water freely, there is a feeling as if bladder was not thoroughly 
emptied in the act of urinating. Urine is likely to contain pus 
to a greater or less extent, often thick, ropy, tenacious, muco- 
purulent matter, and perhaps blood. Always blood corpuscles 
and vesical epithelium under microscope. The act of micturition 
suddenly stopped, in large per centage of cases, by stone being 
forced against the neck of the bladder, when, if the patient 
suddenly throws himself upon his hands and knees, thus caus- 
ing the stone to move away, the flow of urine returns ; tenes- 
mus, prolapsus of the rectum, very common. None of those 
symptoms are to be positively relied on, not one, until a metal- 
lic sound or silver catheter is introduced, when the bladder is 
full, and the stone felt by its impulse on the fingers, and the 
peculiar click is heard by the ear. One examination should 
not suffice, it should be made at least three times, on different 
days, before a final opinion is given. 

Treatment of Stone in the Kidney, if Uric Acid or Red 
Gravel is the Cause. — Plain, nourishing food, milk, eggs, 
fish, animal food ; nothing to increase uric acid ; avoid alcohol ; 
mucilaginous drinks, linseed tea, infusion of marsh mallow ; 



DISEASES OF THE URINARY ORGANS. 459 

daily bathing, flannel clothing ; belladonna plaster over kid- 
neys ; check haemorrhage ; alteratives and tonics, selecting saxi- 
fragica, hydrangea, iodide potass, solution of potassa, citrate 
of potash in alternation with nitric acid in compound tincture 
cinchona, benzoic acid and borax. To relieve pain, if it drops 
into ureters, inhale a little chloroform. When patient feels 
slightly exhilarated, follow with hyperdermic injection of mor- 
phia, and discontinue the chloroform. 

If the Stone has reached the Bladder, and is small, patient 
might be encouraged to take copious warm mucilaginous drinks, 
with nitrate of potass and cream of tartar ; go into a hot bath ; 
take a large dose of tincture of green root gelsemium; dry off; 
smear perinseum with extract of belladonna ; let urine accumu- 
late, and then discharge it forcibly. If that fail, an attempt 
might be made to dissolve it, if acid, by injecting alkalies or 
alkaline solutions ; if a phosphatic calculi, acid solutions. In- 
jecting solvents in the bladder must be done carefully ; the water 
must be tepid, and not too strong of either the alkali or the 
acid — just strength enough for stomach : the liquor potassa, say 
a drachm to four ounces of water; nitric acid dilute, from fifteen 
to thirty drops to four ounces ; used about three times per week. 
At the same time the patient should be placed upon an alter- 
ative and tonic course, with iodide potass in a vegetable alterative, 
and nitric acid in compound tincture cinchona as a preference. 
In the interval, patient should be encouraged to drink freely 
of an infusion of hydrangea and saxafrigica — two remedies of 
great value in causing the disintegration of all calculi, espe- 
cially the phosphatic ; they are true solvents, causing the stone 
to break down into a mealy powder, which is easily passed by 
the urethra. Their action is purely chemical ; they perform 
what no other remedy or combination of remedies can perform. 
Their best effects are to be obtained by infusion ; fluid extracts 
become worthless; ozone-water has a powerful effect on the 
more solid forms, and reduces them to a pulp, which is grad- 
ually eliminiated by the urine. 

Disease of the Suprarenal Capsules. — A tubercular de- 
posit in the suprarenal capsules, which gives rise to excessive 
anaemia, with bronzing of the skin. It is supposed to bear a 
strong analogy to the white cell disease present in enlargement 
of the lymphatics and induration and hyperthropy of the spleen ; 
that the suprarenal capsules evidently aid in the elaboration of 
red blood, or that the great co-ordinating chemical centre at the 
base of the brain is at fault. One thing is certain, that in the 
pigmentary gland of the skin there is a secretion of indicum, 
which, by the action of the oxygen in the atmosphere, becomes 
charged with a bronze color. The obscurity that surrounds the 



460 DISEASES OF THE URINARY ORGANS. 

disease has not been dispelled by modern investigation on the 
subject. 

The cause of disease in these capsules is unknown. 
Sypmtoms. — Comes on very gradually; failing health, 
debility, languor, loss of appetite, feeble pulse, irritability of 
stomach, progressive emaciation ; paroxysms of gastric irrita- 
bility, and vomiting, with faintness, which indicate disturbance 
of the brain. There is usually a persistence of albumen in the 
urine ; a gradual discoloration of skin, most marked about face, 
hands, nec v , arms, circumference of navel, gradually becoming 
of a dingy, bronzed, or smoky hue. The discoloration is not 
present in all cases. Dark patches on the mucous membrane 
of the mouth often present. The chief characteristics of the 
infiltration of the suprarenal capsules are extreme exhaustion, 
sinking, anaemia, albuminuria, and discoloration. 

As our knowledge of the disease is so unsatisfactory, all that 
can be done in treatment is to maintain vital power, with good 
food ; relieve the prominent symptoms, administer alteratives 
and tonics ; apply ozonized clay over region of capsules. In 
spite of everything our best means are baffled, death taking 
place from extreme anaemia in about eighteen months. 

ACUTE INFLAMMATION OF THE BLADDER. 

A partial death of the bladder may arise from the use of such 
drugs as cantharides, turpentine ; from mechanical irritation, 
as calculi; introduction of instruments; or by ignorant use of 
forceps during parturition; external injuries, or blows, falls, 
concussions ; from disease of the rectum, vagina, uterus, pros- 
tate, especially inflammation of those organs ; to gonorrhoea and 
other poisons ; to the use of injections. 

Symptoms. — Commences with rigors and a fever, heat, pulse 
and respiration greatly increased ; wiry pulse ; pain over region 
of bladder ; intense heat of urethra and base of the bladder, 
where inflammation is most intense ; constant desire to make 
water, which comes away in little dribs ; great mental depres- 
sion, and constitutional disturbance becomes greater ; nausea; 
vomiting. Bladder can be felt as a small, rounded, tender 
tumor. Severe pain, extending to perinaeum and down the 
thighs; increased by pressure, rectal or vaginal examination. 
Tenesmus, unless patient is relieved, pain becomes unbearable. 
The calls to micturate become constant ; urine is expelled drop 
by drop, or there is retention ; urine becomes fetid and alka- 
line, containing shreds of lymph, fibrin, entangling pus, and 
blood-corpuscles; great prostration; cold, clammy sweats; 
cadaverous appearance ; low muttering delirium ; fatal ex- 
haustion. 

Its duration is from one to two weeks. Gangrene of bladder 



DISEASES OF THE URINARY ORGANS. 461 

liable to occur. When well managed the symptoms subside, 
and the inflammation terminates in resolution or recovery. 

Treatment. — Patient is usually found on back with knees 
drawn up — a most convenient position for the application of 
stimulants ; apply over region of bladder, first mustard, and 
then hot linseed meal poultices, made with glycerin. If possi- 
ble, empty bowels with oil ; if not, with enemata of infusion of 
marsh mallow and opium. If vomiting is persistent, apply 
mustard over stomach, and begin at once with pretty large 
doses of tincture of green root of gelsemium and pulverized 
opium ; administer in small doses until there is a perfect alle- 
viation of pain, and if necessary push to narcotism. If that 
takes place, patient must be turned over on right side. Incor- 
porate tincture of opium in poultice, and introduce supposito- 
ries of opium and belladonna per rectum. Drinks to consist 
of infusion of linseed or marsh mallow, with nitrate of potassa 
and cream of tartar, enough to keep urine alkaline. If indi- 
cations are bad, dissolve one or two grains of sulphate of mor- 
phia in one ounce of tepid water, and inject into bladder. If 
exhaustion is predominant, cream, raw eggs, essence of beef, etc. 

As soon as symptoms of inflammation have subsided, put 
patient upon compound tincture cinchona and nitric acid, 
or aromatic sulphuric acid and quinine, with an infusion of one 
or other of the astringent diuretics, as buchu, uva ursi, queen 
of the meadow, pareira brava, cleavers, pipsissewa, as a drink ; 
the idea being to restore the tone and vigor of the bladder. If 
convalescence is slow, alteratives. The greatest possible atten- 
tion should be paid to diet ; let it be most nutritious, avoiding 
fat, sugar, starch, malt or spiritous liquors, or anything likely 
to cause acidity. The skin should be well stimulated by alka- 
line sponging daily, and the constant use of flannel. 

CHRONIC INFLAMMATION OF THE BLADDER. 

Catarrh of the bladder is the most common form of inflam- 
mation. It may follow an acute attack ; more frequently it is 
due to gout, rheumatism, venereal diseases, or excesses; damp, 
cold, exposure; foreign bodies in th e bladder ; retention of decom- 
posing urine, or urine charged with uric acid crystals ; excessive 
drinking ; certain drugs, as cantharides, balsam copaiba ; exten- 
sion of inflammation from rectum, prostate, or uterus ; to the 
natural decay of age. 

Symptoms. — Besides a general feeling of debility or indis- 
position, there is an urgent desire to void urine frequently, with 
pain in the urethra. Tension and increased sensibility of the 
walls of the bladder ; often distension from an accumulation of 
urine ; mucus in urine greatly augmented, and of an unnatural 
color ; first it is gray, then yellowish or greenish, thick, viscid, 



462 DISEASES OF THE URINARY ORGANS. 

ropy or streaked with blood. When ulceration sets in, urine is 
loaded with pus. This is the true characteristic of the affec- 
tion. The quantity of this muco-purulent matter is often im- 
mense, averaging several pints a day. 

If permitted to progress, the strength greatly diminishes, 
rapid emaciation takes place, and hectic. 

In the earty stages, under proper treatment, recovery may 
take place ; but if there is a large amount of ropy pus, indi- 
cating extensive ulceration, and vital force much impaired, a 
favorable termination may not take place. 

Treatment. — Indispensable to a successful medical treat- 
ment, is the very best of food of the most nourishing charac- 
ter ; daily bathing, flannel clothing, external warmth ; bowels 
regulated to one motion a day. An alterative and tonic course 
all through; such alteratives as ozonized phytolacca or saxi- 
fraga ; compound syrup stillingia and iodide potass, or ozonized 
glycerin; tonics, compound tincture cinchona and nitromuri- 
atic acid, or aromatic sulphuric acid and quinine, or collinsonia, 
bayberry, and hydrastis. While pursuing the alterative and 
chronic course, alteratives two hours after meals, tonics before 
meals. The patient at convenient intervals during the day and 
evening should drink infusions of one or other of the astringent 
diuretics, either buchu or uva ursi, pareira brava, queen of the 
meadow, couch grass, pipsissewa, cleavers. Whichever two di- 
minishes the muco-purulent matter in the urine should be 
selected as the best ; remedies to be changed weekly. If patient 
cannot empty bladder, draw off with catheter, and wash out 
bladder with infusion of hydrastis and borax, or bayberry and 
opium. Urine very acid, equal parts of cubebs and cream of 
tartar, or infusion of linseed and sweet spirits of nitre, to be 
taken. If there are either continence or incontinence of urine, 
a suppository of belladonna and opium at bedtime. Drinks to 
be of a demulcent character, and to be taken sparingly. Any 
pain over bladder, apply ozonized clay during the night, and 
poultice during the day. Alcoholic drinks to be forbidden. If 
the urine is loaded with, or even exhibits traces, of cancer- 
germs, tubercle, amoeba, or the yeast fungus, inject into the 
bladder an infusion of wild indigo and borax, and administer 
ozone-water internally. Patience and close perseverence to the 
above treatment will usually result in a good cure. 

INCONTINENCE AND CONTINENCE OF URINE. 

The sphincter muscle of the bladder is liable to suffer partial 
or complete loss of tone, or paralysis. This may occur with a 
condition of relaxation or a state of contraction, hence the 
terms incontinence and continence of urine. The cause in 
either is inherent weakness of organization, or some irritation. 



DISEASES OF THE URINARY ORGANS. 463 

Either may occur in the old or young; rarely during middle life. 

(1.) Incontinence in the Young.— Incontinence, or ina- 
bility to hold the urine, so that it flows or dribbles away during 
the day or night, is the most common,- and may depend on 
disease of the kidneys, or gravel, or the uric acid diathesis, or 
to the presence of urates in the urine ; cold ; wet ; seat-worms ; 
long, contracted, foreskin ; falls or blows on the back ; nervous 
debility. 

In young children it is favored by excessive drinking of 
fluids during the day ; by being put to bed between cold sheets ; 
by lying on the back, a position that causes passive congestion 
of the lower part of the cord, and very unfavorable for reten- 
tion of urine, especially when the natural sensibility of the 
mucous coat of the bladder is increased. It may also be caused 
by habit, fright, fear, or passion. When due to inherent weak- 
ness of organization, the difficulty seems to be entirely limited 
to the nerves of the sphincter muscle, impairing power of 
contraction. 

Treatment. — The treatment is very simple : daily bathing ; 
flannel clothing ; to sleep between warm blankets ; diet to be 
of the best and most nutritious kind ; bladder to be emptied 
before retiring to bed, and child instructed to retain it during 
the day ; either the application of a strengthening plaster, or, in 
some cases, a belladonna plaster, over loins or sacrum, and pre- 
cautions taken to keep the child, if possible, on right side, and 
have him waked up before the regular hour of retiring to have 
bladder emptied, and every means resorted to to restore tone and 
strength to the system. All causes, such as seat-worms, long 
prepuce, etc., should be removed. First of all, try tincture of 
iron in alternation with tincture of belladonna. Regulate dose 
to age; then try sulphate of cinchona in alternation with wine 
of ergot; or tincture cinchonia compound and collinsonia. If 
due to acidity, the mal-nutrition to be corrected by tonics, 
changes of diet, open-air exercise, etc. 

Incontinence in the aged is generally due to sexual excesses ; 
enlargement or degeneration of prostate ; a breaking-down of 
the nervous system ; nervous disease, especially affecting lower 
portion of the cord ; to uric acid, or oxalate in urine; stone in 
the bladder ; disease of the walls of the bladder ; piles, falling 
of rectum, stricture of the urethra, vascular tumors of rectum, 
ovarian or uterine diseases or displacements, pregnancy, coition, 
hysteria, etc. 

If the cause admits of removal, get rid of it, and place patient 
upon alteratives and tonics ; inculcate daily shower-baths, good 
food, flannel clothing, stimulating plasters to loins ; if due to 
sexual excesses and nervous debility, rich phosphatic diet, 
glycerin of kephaline, or ozone ; tincture damiana compound, 



464 DISEASES OF THE URINARY ORGANS. 

and if prostate is enlarged, infusions of hydrangea and saxi- 
fragica. Sulphate of quinine, iron by hydrogen, and extract of 
nux pill are very valuable here, in conjunction with the general 
and alterative course. The use of phosphorus-water, phos- 
phorus pill, in fat, tincture or infusion of phosphorus, are to 
be forbidden, as they tend to fatty degeneration, not only of 
the heart, but erectile fibres of penis, and hasten prostatic de- 
generation. 

(2.) Continence of Urine in the Young. — An inability to 
urinate, from contraction of the sphincter muscle of the bladder, 
is common in children, and arises from the same causes that 
give rise to incontinence, inherent weakness of organization, 
tuberculse, acidity, cold, wet, fright, etc. 

In the treatment, remove the cause, and then try the warm 
hip-bath ; hot poultices of roasted onions, crushed, to pubes and 
perinseum ; administer warm linseed tea, with nitrate of potassa 
and cream of tartar ; cause the imitation of a stream of urine, by 
pouring a quart of water through narrow tube of coffee-pot into 
water and within heari ng of patient. All failing, steam buttocks 
with hot water and tobacco ; use injection into rectum of water 
with belladonna; administer lobelia and belladonna internally. 
If all fail, the urine must not be permitted to remain in the blad- 
der over a few hours ; it must be drawn off at least three times 
a day until the condition can be permanently relieved by other 
remedies. Then other means : keep urine alkaline ; use daily 
baths ; flannel clothing ; bowels regular. Try first tincture of 
iron in alternation with belladonna, cinchona, cinchonia; gen- 
eral tonics, with every means to improve general health. 

Continence in Ladies is frequently brought about by over- 
sensitiveness or modesty, in the long retention of their urine. 
They, from the extreme width of their pelvis, are enabled to 
hold their urine longer than men, and by such long retention 
seriously injure the sphincter muscle by stretching. 

In such cases, adopt the usual means ; all failing, draw off by 
catheter, and then use infusion of uva ursi. 

Occurring in or during pregnancy, no remedies to be used ; 
patient to be solicited or encouraged to make water in recum- 
bent posture, if failing to be drawn off by catheter. 

Continence in the Aged. — Old men are its victims, and 
especially those who have been what the world calls fast, having 
exhausted their physical and mental powers by alcoholic drinks 
and sexual excesses ; men with diseased prostates, either degen- 
erated or hypertrophied ; men who are used up by excess and 
over-stimulation ; cold, wet, exposure, excesses, horseback exer- 
cise. Acid urine, as in rheumatism and gout, may excite the 
suppression ; but in ninety-nine cases out of one hundred a 
diseased prostate is at the bottom of the trouble. 



DISEASES OF THE URINARY ORGANS. 465 

In the treatment of continence, before drawing off by cathe- 
ter, — the hot bath, hot hip-bath, hot poultices of lobelia and 
belladonna to pubes and perinaeum; suppositories of bella- 
donna ; warm drinks of cream of tartar and nitrate of potass ; 
tincture of green root gelsemium and belladonna internally ; 
all failing, use catheter. Then use alteratives and tonics, but 
especially hydrangea or saxifragica in infusion. 

Cinchona acts well in all its forms, as also iodide of potass. 
During the alterative and tonic course, suppositories of bella- 
donna and iodide potass at bedtime. 

Avoid horseback exercise, sexual congress, drinking, either 
spirits, malt liquors, or wines. With the disappearance of dis- 
eased prostate, both continence and lost virile power soon give 
way, and even an aged man may feel free from the incumbrance 
of such an affliction. 

The anterior portion of neck of bladder being covered by 
branches of sympathetic nerve, explains why emotions, desires, 
affections, passions, have such an influence in causing inconti- 
nence and continence of urine, in all ages and in both sexes, 
especially the female. 

IRRITABLE BLADDER. 

Irritability of the bladder is said to exist when there is an 
unnaturally frequent desire to pass urine. 

It may arise from organic disease of the spinal cord, kindeys, 
bladder, prostate gland, or urethra; vascular tumors in the 
female urethra; pressure of the gravid uterus; irritation of 
piles, or intestinal worms ; presence of a tumor or stone in the 
bladder; catarrh and ulceration of bladder; acid urine, or 
functional derangement of .the kidneys, bladder, stomach ; and 
to shock to sympathetic nerve, and irritation of adjacent organs. 

Symptoms. — The desire to micturate comes on suddenly, 
frequently, and irresistibly ; urine may have to be passed every 
fifteen minutes — an inability to resist the desire ; if attempted, 
great uneasiness or aching pain. The total amount of urine 
passed in the twenty-four hours very rarely increases in 
quantity ; bladder diminishes in size ; the general health begins 
to suffer. 

Treatment. — If possible, remove the cause ; and in order to 
do that the urine must be examined, to see if it is acid or alka- 
line ; if loaded with urates, or phosphates, or oxalates ; or if it 
contain albumen, or pus, or sugar, or any morbid material, and 
disease traced to its origin, which remove. Patient's bathing, 
diet, and drink, regulated to nature of malady at the base 
of difficulty. Alteratives and tonics, irrespective of cause^, 
changed weekly, and persevered with ; suppositories of bella- 
donna and opium every night. Then try special drugs to act 

42 



466 DISEASES OF THE URINARY ORGANS. 

upon bladder, as buchu, uva ursi, pareira brava, queen of the 
meadow, cleavers, couch grass, pipsissewa. Select one ; infuse 
about one ounce to half a pint of clear infusion every night ; 
let it stand on stove over-night to draw ; to be used next day ; 
the two that acts best to be selected for regular use. Try, also, 
the action of nitromuriatic acid ; tincture of iron ; tincture of 
benzone, cantharides. 

If not of old standing, belladonna plaster to loins; avoid 
all stimulants, even tea and coffee — anything that aggravates 
the difficulty ; no mental anxiety or other depressing influences. 

SPASM OF THE BLADDER. 

All muscular structures are liable to attacks of spasmodic 
action ; the bladder having such a coat is frequently affected 
with spasm. Spasmodic attacks are accompanied with great 
pain, as well as contraction. 

Causes. — The presence of a stone in the bladder ; disease of 
the rectum or uterus ; abscess of kidney ; an inordinate amount 
of uric acid ; ulceration of the walls of bladder ; disease of pros- 
tate gland ; excessive sexual congress ; hysteria ; the use of 
drastic diuretics or emenagogues, as oil of turpentine, juniper, 
cantharides, savin. 

Symptoms. — Severe pain in the lower part of the abdomen, 
extending to urethra. There is either continence or inconti- 
nence, or dribbling of urine. The difficulty is not so great 
when the urine flows involuntary ; when there is retention, 
with urgent desire to micturate, and tenesmus, with inability 
to do so, suffering is great. If allowed to continue, may termi- 
nate fatally. 

Treatment. — If patient is seen during the attack, hot baths, 
enemata of warm water and lobelia ; fomentations or poultices, 
with belladonna, linseed poultices, with lobelia and belladonna ; 
suppositories of opium and belladonna. 

Internally, mucilaginous drinks, with cream of tartar and 
nitrate of potass ; either the compound of lobelia, valerian and 
capsicum, or else sumbul and tincture of green root gelsemium. 

When attack is over, removal of cause, alteratives and tonics, 
iodide potass and sulphate of quinine. 

Diet regulated, an avoidance of all stimulants ; tea, coffee, 
warm clothing; forbid horseback exercise, or sexual intercourse, 
and appropriate remedies as to cause. 

PARALYSIS OF THE BLADDER. 

The muscular coat of the bladder may become paralyzed 
from diseases incidental to the bladder itself; from disease of 
the nervous system, especially the spinal centres, or from con- 
stitutional debility. 



DISEASES OF THE URINARY ORGANS. 467 

The paralysis may be due to over-distension of the bladder, 
an excessive stretching of the muscular coat, brought about by 
holding the urine too long ; old age, with diseases incidental 
thereto ; disease-germs and blood poisons, as gout, rheumatism, 
syphilitic and tubercular disease ; enlargement of the prostate 
gland; pressure of the head of the child in labor, if long or 
tedious. 

Symptoms. — When the bladder is paralyzed its contents are 
retained ; but when the distension becomes very great the mus- 
cular fibres of the contracted sphincter are stretched apart, and 
the urine begins to dribble away by the urethra ; hence the 
inexperienced are apt to be led astray, taking it for a case of 
incontinence. But if the hand be placed above the symphysis 
pubis the bladder can be felt, as an immense enlargement. 
Urine is highly ammoniacal, loaded with mucus, pus and phos- 
phates. Pain at the neck of the bladder and glans penis is not 
to be depended on as a symptom, because the bladder loses its 
sensibility, and the desire to void urine is not experienced. 

The constitutional disturbance is usually severe ; the pulse 
becomes quick, wiry, feeble; the tongue coats; appetite fails; 
great restlessness and depression ; vital power grows feeble, and 
the patient, if not relieved, sinks into a state of stupor, and dies 
of exhaustion. 

Treatment. — Empty the bladder by the catheter ; then wash 
it out with a tepid infusion of hydrastis and borax, or bayberry 
and iodide of potass. 

Remove the cause, and then, after using the following rem- 
edies a few days, select the ones that afford most relief: tincture 
of nux, iron, calabar bean, gelsemium, erythroxylon coca. 

Alteratives and tonics, not forgetting the astringent diuretics ; 
cups, galvanic cautery, belladonna plaster to spine. 

TUMORS IN THE BLADDER. 

A large number of growths are developed from the walls of 
the bladder : warty, or polypoid fibrous bodies ; villous, or 
vascular growths, and cancerous deposits. 

Whatever the nature of the growths, they give rise to symp- 
toms that resemble calculi — frequent micturition, a painful 
sense of inability to empty the bladder ; urine may be bloody, 
or purulent, or ammoniacal, or loaded with mucus. 

Cancerous deposits are the most numerous ; medullary, epith- 
elium, more common than scirrhus ; suffering great; easilv 
recognized by the pain anterior and posterior, the cachexia, 
and germs in urine. 

Treatment. — See Cancer. If patient is seen early, the ozon- 
ized clay has a marked effect over the bladder, with ozonized 
remedies internally. 



468 DISEASES OF THE MALE ORGANS OF GENERATION. 



DISEASES OF THE MALE ORGANS OF 
GENERATION. 



BALANITIS 

Consists of an irritation, inflammation, with, a shining, glisten- 
ing redness, or excoriation of the covering of the glans penis 
and inner aspect of the prepuce. Some call it balanitis when 
the glans only are affected, and balanitis-posthitis when both 
glans and internal lining membrane of prepuce are involved. 
The distinction is unnecessary and altogether uncalled for, as 
the two conditions are essentially the same. 

Causes. — Excessive sebaceous secretions around corona glan- 
dis often gives rise to it in boys and virtuous young men, and 
causes anxiety, which ignorant or knavish physicians will 
magnify into something venereal, so as to extort a fee. Rubbing 
of clothes, chafing in hot weather, masturbation, a natural 
rankness in some women, will cause it in highly-organized and 
susceptible men ; catamenial discharge, and the venereal germs. 
From whatever cause it arises, it can be communicated to the 
opposite sex by contact; as the parts, whether dry or freely 
exuding muco-purulent matter, are freely covered or filled with 
bacteria. So, in dressing, the cleaning of vessels, destruction 
of dressing, and great cleanliness, especially about hands, lest 
any of the matter reaches the eye. 

SymDtoms. — Heat, redness, itching about the glans. In 
some cases it is of a smooth, shining redness ; in others, a muco- 
purulent discharge. On uncovering the glans, by drawing back 
the prepuce or foreskin, patches of redness and excoriations are 
perceived, with flakes of curd-like matter. If there be swelling 
of the foreskin, or if its sphincter fibres are irritated, it may be 
contracted, so that it cannot be drawn back over the head of the 
penis, so that retraction is impossible, and then there is phi- 
mosis. There are many reasons why the foreskin should be 
drawn back in cases of this kind ; there may be a perforating 
ulcer, a chancre, or an abscess, or mortification may be taking 
place ; bubo from the irritation may take place ; there may be 
a gonorrhoea, or an indurated or infecting chancre. 

Vulvitis in women is an analogous affection. 

Treatment. — Draw the foreskin gently back ; make a wash 



DISEASES OF THE MALE ORGANS OF GENERATION. 469 

of permanganate of potass, ten grains to the pint of water, or a 
tablespoonful of borax to the pint ; take a small sponge, satu- 
rate with the wash, and squeeze it so that it drops from a height 
of twelve inches on the affected part. • Continue this douching 
till the pint is used ; do it three times a day. After having 
performed this, press gently a fine piece of muslin, or silk, on 
the affected part, so as to dry it ; then smear it over glans and 
prepuce with ozone ointment. When the foreskin can be drawn 
back, this plan will effect a cure in a few days. The ozone 
ointment could be spread on a thin layer of cotton-wool if de- 
sired. In cases where the foreskin cannot be drawn back, take 
a small gonorrheal syringe, and inject round and round it 
with same wash. If an ulcer, or chancre, or gangrene is sus- 
pected, circumcision, slitting up of prepuce; or sometimes it can 
be relaxed with a warm poultice and belladonna. If there is 
danger of contraction, a little cotton-wool smeared with oint- 
ment should be kept applied. 

Mothers should be instructed to draw back the foreskin in 
the daily ablutions of the child, and apply a little oil to unite 
with the sebaceous secretion, and then wash off. Young men 
should follow same practice every day. This would not only 
promote health, vigor, and growth of the penis, but would do 
much to prevent masturbation, nocturnal emissions. 

It would have a salutary effect. The oil need not be used 
unless there is the white, cheesy secretion ; it will suffice to 
drop cold water on its neck, with the foreskin retracted, or 
drawn back. 

PHIMOSIS. 

A preternatural contraction of the foreskin over the head of 
the penis, preventing its being drawn over the glans penis. 

Causes. — It may be congenital, and give rise to obstructed 
micturition in the infant ; or it may be acquired in after-life, 
by the irritation of the sebaceous secretion, by clothes, chafing, 
masturbation, gonorrhoea, or irritation ; from discharges in the 
female. 

Symptoms. — In children and adults, there is the long, con- 
tracted foreskin, which gives rise to obstruction in urinating, 
resembling stricture, or stone in the bladder. In some cases, 
an inability to urinate. In adults, the swelling, elongation, 
and contraction is generally due to masturbation, gonorrhoea, 
chancres, and often causes great swelling of the areolar tissue 
and balanitis. 

Treatment. — Warm bathing, hot hip-bath, with tobacco and 
belladonna ; the local application of lobelia and belladonna ; 
injecting a hot infusion under foreskin. If once back, a thor- 
ough ablution with warm water and lobelia ; cotton-wool, with 



470 DISEASES OF THE MALE ORGANS OF GENERATION. 

ozone ointment, around head and neck ; and then pull foreskin 
over, and repeat three times a day, inculcating rest, and bowels 
freely opened with salines. Get rid of cause upon which it 
depends. 

If all means fail, circumcision should be performed. This 
is performed in a variety of ways. 

As introduced by that great pathologist, Moses, to prevent 
the dissemination of the venereal disease, it consisted in a sim- 
ple slitting up of the entire length of the foreskin to the rim or 
neck on the upper or dorsal aspect, and excising a small piece 
like a V. This answers well enough in children or very young 
persons, because the two bags or ears that are left are easily and 
quickly absorbed. The better plan in adnlts,is an entire excision 
round, only not interfering with the frsenum or bridle on the 
inferior aspect ; first slitting it up, and then clipping it off neatly 
with the scissors ; inserting eight or nine lead wire sutures ; 
stitching the edges of the mucous membrane to the skin. 
Subsequently, dressing with some antiseptic lotion, as lime- 
water, tincture of iodine, borax, and glycerine ; keeping all the 
time moist; changing and destroying dressing twice a day. 

PARAPHIMOSIS. 

This is a condition in which the nerves that supply the 
circular muscular fibres of the foreskin are irritated ; there is 
a preternatural contraction, but the tight prepuce is behind 
the glans penis, that is, drawn back over it, whereby the head 
of the penis becomes constricted, swollen, and in some cases so 
engorged with blood that the prepuce cannot be replaced. 

The causes are the same as phimosis. 

Symptoms. — Great swelling before and behind the constric- 
tion at the neck. The mucous membrane forms a thick, 
brawny girdle, like a tightened rope. Great congestion of 
glans penis. Pain, inflammation, ulceration, gangrene of head, 
if neglected. Violent constitutional disturbance. 

Treatment. — Hot bath; then warm hip-bath, with tobacco; 
enemata of lobelia; then sit patient down in a chair, the phy- 
sician or operator sitting opposite with a yard of silk ribbon 
in his hands, the width of the glans penis. Place the centre 
of the ribbon on the dorsal or upper aspect of the glans penis, 
drawing each end downwards, forming a loop ; then place one 
end of the ribbon round the second finger of right hand, to 
form a loop; the other on the same finger of the left. That 
will leave the index finger and thumb on each hand free for 
manipulation ; then tighten, compress glands gently but firmly; 
keep compressing steadily, and soon as you perceive a de- 
crease in size taking place, persevere still, and while thus 
compressing, catch the constricted prepuce with index finger 



DISEASES OF THE MALE ORGANS OF GENERATION, 471 

and thumb of each hand, still compressing; pull the prepuce 
over the glans penis. If you are unable to accomplish that, a 
notch, although we are partial to incision of the prepuce at 
several points, if only one, let it be a free one, at the tight, 
preputial collar. 

If several incisions are made, say five or six, it is equal to 
circumcision, for in the process of healing, the foreskin entirely 
disappears. 

Unless there is some legislative enactment made to prevent 
the spread of syphilitic disease, it would be well to reinstate 
one of the best and wisest methods of protection or prophylaxis, 
the Mosaic sacrament of Circumcision. There can be no 
doubt but that the circumcised are a highly-favored and chosen 
people, having a great immunity from this terrible disease- 
germ. 

HERPES PREPUTIALIS. 

A contagious affection of the prepuce, consisting of clusters 
of vesicles, usually upon a non-inflamed base, in size from the 
head of a pin to that of a small pea, sometimes isolated, in 
other cases, in patches. The contents of the vesicle are simply 
a mass of living diseased germs. Although readily communi- 
cable from one to another, or from the serum or germs run- 
ning on the skin or mucous membrane, and being originally 
the result of a degradation of normal bioplasm, still it is doubt- 
ful if it can be regarded as a venereal affection. 

Treatment. — As soon as a vesicle forms or fills, puncture it 
with a needle, and let its contents escape, and press a sponge 
saturated with lime-water and tincture of iodine lotion, or with 
a lotion of permanganate of potash ; then dry by gentle pres- 
sure, and apply ozone ointment. There is no use in caustics, 
as the disease will reappear after their application, In all 
cases, alteratives and tonics for a few weeks. If a married 
man, same precautions as to wife, and abstinence from sexual 
congress till both are well. 

INFLAMMATION OF THE URETHRA. 

May exist in either an acute or chronic form, independent of 
the venereal poison, or so-called gonorrhoea. 

Causes. — May be due to mechanical violence, passage of 
calculi, strains, blows, excessive sexual congress, the catamenia 
or rankness in some ladies, horse-back exercise. 

Symptoms. — Pain, heat, redness, swelling ; very great pain 
in micturition if urine is acid; muco purulent discharge; irri- 
tability of bladder; there may be chordee, a bent or crooked 
condition of penis during erection, from a lesion of its erectile 
fibres; if so, there may be blood; lips of urethra often much 



472 DISEASES OF THE MALE ORGANS OF GENERATION. 

swollen; often retention of urine, with fever and constitutional 
disturbance. 

The discharge is contagious, because it is heavily loaded 
with bacteria, with a few amoeba. If severe, liable to give rise 
to stricture and gleet, same as gouorrhoea. 

Treatment. — Rest in bed; hot hip-baths; open bowels with 
salines ; keep urine alkaline with nitrate of potassa and cream 
of tartar, drinks of linseed tea, tincture of green root of gelse- 
min in thirty-drop doses, every three hours ; when inflamma- 
tion has subsided, pulverized cubebs and cream of tartar, or 
kava kava or golden tincture. Chronic form, use same reme- 
dies. 

STRICTURE OF URETHRA. 

In inflammation of the urethra, from the intense congestion 
of the capillaries of the mucous membrane of the urethra, 
the calibre of the urethra is often diminished in size, or other- 
wise altered, which causes the stream of urine to be as fine as 
a thread, or twisted, or forked, or scattering, or even suppressed ; 
this, by some, is erroneously called inflammatory stricture, 
whereas it is the stage of inflammation called dry clap, or 
congestion. 

In chronic inflammation of prostate, with hypertrophy of 
either of the lobes of the gland, the morbid condition imparts 
a hyperemia to the urethral nerves, which is much influenced 
by nervous states, weather, cold, damp, etc., in which there may 
be retention, or if able to micturate, stream will be small, cork- 
screw shaped, split, forked, etc., which is most erroneously 
termed nervous stricture. 

What we mean by a true organic stricture, is an effusion of 
lymph, and its organization into a band or bands, or an elon- 
gated infiltration, causing an impediment to the escape of the 
urine, or causing the stream to be small, twisted, split or forked, 
or like a cork-screw; and if a silver catheter, warmed and oiled, 
be introduced, it can be felt on the lower aspect of the urethra, 
where it forms an obstruction to the entrance of the instrument ; 
and as it is permanent it can always be found in the same 
position. In all forms of inflammation of the urethra, the 
stress of irritation is on the lower surface ; hence, strictures, 
chancres, breaks, are located in this position. 

Treatment. — The object to have in view is the improvement 
of the general health and absorption of effused lymph. The 
remedial measures, therefore, must be good diet, tonics, and 
alteratives, as cinchona and mineral acids ; iodide potass in 
some vegetable alterative. It is to be distinctly borne in mind 
that, although modern science and art have done much for the 
urethra, that what has been achieved possesses no practical 



DISEASES OF THE MALE ORGANS OF GENERATION. 473 

utility. There is neither good sense, nor judgment, nor reason, 
nor science, in forcibly tearing up a stricture within a poor 
fellow's urethra with Holt's dilator, when in six weeks it will 
have returned worse than before ; neither is there utility nor 
common sense in slitting them up with the stilleto, or burning 
them out with the galvanic cautery, when in the short space of 
a few weeks they will be worse than before. The only true 
method is absorption, which should be carried out in the 
following manner: Patient carrying out alterative treatment 
internally ; every second day a silver catheter, warmed and well 
smeared with vaseline ointment, in which iodide potass and bella- 
donna are incorporated, should be introduced, pressing the point 
of the instrument, in passing over the stricture or strictures, well 
up against the upper aspect of the canal ; carry the point u p to the 
prostate. A catheter that will pass easily should be used, patient 
in recumbent posture, and it should remain half an hour. This 
is to be repeated every second day, gradually increasing the 
size of the instrument until a No. 12 passes easily, and even 
after that continue for four or six w T eeks longer. Never dilate, 
the presence of the metallic body, from time to time, causes a 
wasting of the lymph, and it gradually and forever melts away. 
If time is an object, forcible dilatation is the next best method. 
This is best accomplished either b}^ placing patient in hot bath, 
administering an enemata of lobelia, or by inhalation of a few 
drops of chloroform, and forcibly introducing a No. 12 catheter 
through or over the stricture, right into the bladder, tying it 
there, and retaining it in that position for a week or ten days, 
patient being kept in recumbent position in bed. During 
that time suppuration takes place along the entire canal ; the 
effused lymph, or stricture, disappears. After the withdrawal 
of the catheter, for a few days it may be necessary to draw the 
water off until the patient regains control of the sphincter. 

FISTULA IN URETHRA. 

If a stricture is not absorbed, it will give rise to irritation of 
the urethra and gleety discharge. The obstruction rebounds 
upon the prostate, and causes chronic enlargement of that 
gland ; besides, in bad cases, a drop of urine is liable to lodge 
behind the stricture, and excite irritation, inflammation, ulcer- 
ation, and ultimately an opening or fistula, through which the 
urine flows or drops when the patient urinates. 

The best method of treatment, patient under an anaesthetic, 
is to carefully dissect out the fistulous tract; then forcibly intro- 
duce through the stricture into the bladder a No. 12 silver cathe- 
ter, and retain; stitch up the wound, and by the time it has 
healed — eight or nine days — stricture will have entirely suppu- 



474 DISEASES OF THE MALE ORGANS OF GENERATION. 

rated away, and an excellent cure of both fistula and stricture 
will be the result. 

MALFORMATION OF URETHRA. 

In children born from incompatible parents, or those related 
by consanguinity, there are two forms of malformation that 
result : 

(1.) Hypospadias. — A congenital malformation ; when com- 
plete, the urethra terminates, or opens, on the under surface of 
the urethra, some distance back, with no orifice at the extrem- 
ity, or point. In some cases, there is a small thread-like opening, 
through which a few drops of urine may flow. 

(2.) Epispadias. — Is the same condition, perfect or imperfect, 
but where the opening is on the dorsum or upper aspect of the 
penis. 

Both conditions render the patient unable to impregnate. 

Treatment. — Patient under anaesthetic, make an opening at 
the extremity, or point of the penis, where the urethra ought 
to be; bore through the tissue in a straight direction with a 
large trocar; when the urethra is tapped at the mal-formed 
opening, withdraw, and introduce a No. 12 silver catheter. 
When you are sure you are in the urethra, dissect out the abnor- 
mal tube, or opening, introduce catheter into bladder, and stitch 
up the old orifice. There must be the greatest certainty that 
the walls of the old mal-formed urethra are well removed ; 
better a little more than too little. Tie catheter in bladder for 
two weeks; at the end of which time the patient will have a 
magnificent new urethra, perfectly formed, moulded on the 
catheter. . 

GLEET 

Is the escape of a white, glarry mucus from the urethra, which 
may be due to, (1.) The presence of a stricture, or thickening by 
lymph. (2.) To an exudation from the prostate gland in catarrh 
and chronic prostatitis. This is the most common of all forms, 
as eighty per cent, of all American males, over thirty-five 
years of age, are afflicted with prostatic irritation. (3.) To a 
weakness or relaxation of the mucous membrane of the urethra, 
the result of inflammation. This latter is what is termed true 
gleet. The symptoms are those of debility. 

Treatment. — Every means calculated to improve the general 
health; good food, daily bathing, especially the shower-bath; 
well-regulated bowels; tonics and alteratives, cinchona and 
mineral acids, glycerite of ozone, tincture of iron. 

Inject urethra with infusion of golden seal, aromatic sulphu- 
ric acid and water, or some mild astringent. 



DISEASES OF THE MALE ORGANS OF GENERATION. 475 

HEMIPLEGIA OF PENIS. 

Due either to congestion or anaemia in spinal cord, caused 
either by blows, falls, or excess. 
General treatment as to cause. 

PRIAPISM. 

Constant and distressing erection of the penis. 

Causes. — It may be due to some injury of the spinal cord, 
as fracture, concussion, occurring at the lower portion of the 
dorsal or upper lumbar vertebrae, or at the origin of the nerves 
in the brain; subacute inflammation of the corpus cavernosa, 
or effusion of lymph or blood into that structure. Both con- 
ditions may be caused by venereal excesses, or masturbation ; 
that is, effusion may take place into the corpus cavernosa from 
the irritation of the 'hand, and the irritation is transmitted to 
the spinal cord and brain, the reflex centre. 

Tteatment. — If due to fracture of the spinal column at the 
point mentioned, or disease of the brain, all that can be done 
is to afford relief until the cause is removed, if it is possible ; 
when due to masturbation, if the practice can be discontinued, 
a cure is usuall} 7 effected. Our chief dependence is to be placed 
upon large doses of tincture of the green root of gelsemium, with 
bromide of potass. The dose here must be large and carefully 
regulated. The gelsemium, in doses of from thirty to sixty 
drops every three hours in divided doses, so as to watch it. The 
bromide, in from thirty to sixty grains during the same period, 
with a few grains of bicarbonate ; it may be given at one dose. 
At the same time, suppositories of balladonna and camphor. 

If due to effusion in the corpus cavernosa, arnica lotions and 
iodoform suppositories are of utility. 

Diet regulated. Cold is sometimes of utility to penis, or ice 
to lumbar portion of spine. There is little good in camphor, 
cocoa, Indian hemp, lupulin, etc. A course of vegetable alter- 
atives and tonics should always be resorted to. 

BUBO 

Is a term applied to irritation, inflammation of the lymphatics 
of the groin. It may consist either of a simple irritation, or 
may depend on absorption of venereal-germs into the lymph 
channels. 

Causes. — It may be caused by a simple inflammation of 
urethra, by balanitis, by masturbation or sexual excesses, long 
walks, horseback exercise, in-growing toe-nail. It may be due 
to the presence of the venereal-germ, chancres, etc. 

Symptoms. — The gland swells, becomes indurated and ten- 
der, fills up with lymph, and when the lymph breaks down, a 



476 DISEASES OF THE MALE ORGANS OF GENERATION. 

suppuration takes place ; there are rigors and pain, burning, 
throbbing. In some cases, fever and great difficulty in walking. 

Treatment. — In order to prevent the irritation of the lym- 
phatics of the groin, all applications to any morbid condition of 
the genital organs should be of a soothing nature. No caustics 
or irritants should be used, or, if used, those should be selected 
that cause no pain ; all applications to be of a soothing character. 

There are various remedies and modes of management, if they 
once form, in order to prevent suppuration. 

Gentle pressure, with plantain-leaves next the skin, or iodo- 
form ointment, or phytolacca, or stramonium ointment, with 
iodide potass. The ozonized clay, without pressure, or hot 
poultices. 

If it is soft in centre, if pain is throbbing, poultices ; if desi- 
rous of hastening it forward . slippery-elm poultices, hot, with 
a good quantity of bicarbonate of soda in them during day, 
and linseed poultices during night. It may open itself, or have 
to be opened. In either event, it must be borne in mind that it 
must heal from the bottom ; that its internal lining membrane 
or sac must be destroyed, as it is a true secreting membrane ; 
so, if opened by the knife, the incision should be made in four 
different directions, so as to destroy its sac and permit it to 
heal from the bottom. If it opens itself, then, after its contents 
have been thoroughly evacuated, inject the sac with tincture 
iodine and iodide of potass, so as to destroy the secreting faculty 
of the internal lining membrane of the sac. 

ACUTE INFLAMMATION OF THE PROSTATE 

GLAND. 

A partial death of this gland may be induced by violence, 
blows, kicks, falls; by gonorrhceal inflammation proceeding 
upwards; by the use of strong caustic injections into the ure- 
thra; excessive venery, masturbation, disease of rectum; a 
metastasis of the poisons of gout or rheumatism in that class 
of subjects exposed to cold or wet; to the action of such drugs 
as cantharides, turpentine, balsam copaiba, etc. 

Symptoms. — Pain in the perinseum, very excruciating, with 
sense of heat; frequent painful micturition, often inability to 
urinate ; great pain and distress in defecation ; a feeling of 
weight and fullness about perinseum and rectum ; suffering 
increases ; rigors and a fever set in, and difficulty of micturi- 
tion increases. The insertion of finger up the rectum gives 
great pain, but by it the gland can be felt, hot, extremely sen- 
sitive, and enlarged. The greatest kind of suffering is experi- 
enced if a catheter is introduced ; aching in hips and thighs, 
with dragging in back. If case is not actively treated, often 
progresses on to abscess. 



DISEASES OF THE MALE ORGANS OF GENERATION. 477 

Treatment. — Hot hip-baths, followed with suppositories of 
belladonna and opium, or enemata of the same remedies. Then 
perfect rest in bed, with either hot poultices or fomentations of 
lobelia, keeping perinseum smeared with belladonna. 

Treat fever with aconite, and as large doses of green root 
tincture of gelsemin as can be borne, with bromide and bicar- 
bonate of potassa, every three hours. If there is inability to 
urinate, draw off with catheter. As soon as fever abates, add 
iodide of potassa to the bromide and bicarbonate 

Infusion of one of the astringent diuretics as a drink, to 
which sweet spirits of nitre can be added to keep urine alka- 
line. Uva ursi or hydrangea is the best. As case progresses, 
alteratives and tonics, iodide of potassa to be the principal. If 
abscess form, incision over fluctuation, followed with poultices, 
nourishing food, tonics. 

Forbid, during treatment, all stimulating articles of diet, 
feather beds, sexual intercourse, liquors, as priapism is often 
present. If there are elements of gout, colchicum and quinine. 

CHRONIC INFLAMMATION OF THE PROSTATE 

GLAND. 

Or, as some term it, chronic enlargement of the prostate, is 
very common ; not as a result of the dignity of a hoary age, 
but rather of the defects and vices of modern civilization. 
The character of the gland is such, that with a slight degree of 
irritation, its different lobes become rapidly filled up with 
lymph, and thus become greatly hypertrophied. The enlarge- 
ment is due to effused lymph, the result of inflammation, 
which, in old age, undergoes calcaieous degeneration. Of the 
male population of North America, it is estimated that eighty 
per cent, of all over thirty-five years of age suffer more or less 
from chronic prostatitis. 

Causes. — It may be a sequel of an acute attack, or may 
come on from the same causes, such as mechanical violence, 
gonorrhoea, irritating injections, diseases of rectum; but by far 
the most common causes are sexual excesses; masturbation; 
imperfect copulation, in withdrawing the penis in the act of 
ejaculation, so as to prevent impregnation ; in having sexual 
congress with women of large or dilated vaginas, or affected 
with leucorrhoea, in whom the contractility or grasping 
power of vaginal walls is impaired, and the tonic action of the 
sexual act on the male is destroyed ; the wearing of condoms : 
the want of compatibility in the sexes. These, and similar 
conditions, prevent the secretion of the prostate, as well as the 
semen from the testis, from being thrown off; the result is, it 
remains in the ejaculatory ducts and excites inflammation; in 
other words, they are imperfectly emptied of their natural 



478 DISEASES OF THE MALE ORGANS OF GENERATION. 

secretion; sedentary habits; incessantly in the saddle, as in 
riding; strictures; the debasing or demoralizing effect of our 
modern sexually exciting literature; drugs that cause a deter- 
mination of blood to those parts ; over stimulation in eating 
and drinking. 

Those are a few of the most common causes of devitalization 
of this gland, the cause of premature decay, loss of national 
vigor or manhood. Although we have stated the disease to be 
of such prevalency and early occurrence, it is usually at a later 
period of life that decided symptoms make their appearance, 
although the enlargement begins early. The increase in size 
is due to a true hypertrophy of the normal structure of the 
gland. This hypertrophy may affect the whole gland, or only 
a lobe, or the two lateral lobes alone, or the middle alone may 
be affected. Again, there may be a separate tumor of prostatic 
tissue embedded in the substance of the gland, or pedunculated 
growths may spring from the surface of the gland and project 
forward on the bladder or back to rectum, often mistaken by 
the ignorant for piles. 

The effects of chronic prostatitis on the spinal cord are bad; 
on the brain even worse ; and as a mechanical impediment to 
the bladder, of the gravest kind; alters the course of the ure- 
thra, lengthens its vesicle end, increases the curve, and dimin- 
ishes the calibre of the canal ; besides, the cavity of the bladder 
may be intruded on by the size of the gland ; its muscular coat 
thickened by frequent straining to void water, and later on 
the ureters may, with the kidneys, become affected. Chronic 
inflammation of the bladder may take place, and its capacity 
be diminished, or it may become sacculated. Although we 
have stated thirty-five as the period in our country of its appear- 
ance, still, as the symptoms are obscure, patients may not seek 
relief for many years thereafter. It is a slow, insidious, but 
progressive disease. The production of prostatic inflammation 
must be regarded as the result of ignorance and wilful violation 
of natural laws, and not as the calamity of age. 

Symptoms. — The symptoms of chronic inflammation of the 
prostate in the early stage, are not of a prominent kind ; indeed, 
the gland may attain considerable size without giving rise to 
much trouble. But decided when there is weakness in erectile 
power, or seminal losses, or obstruction to urinating, or urine 
escaping with the stools, stream weak, more difficulty in turn- 
ing it on or off, besides increased frequency in micturition, with 
more irritability of the gland ; if unmarried, nocturnal emis- 
sions, one after the other, or a morbid desire for sexual inter- 
course ; often a slight gleety discharge, which keeps the urethra 
red, tender, or sore. The enlargement causes a mechanical 
impediment to the function of the rectum, as well as the 



DISEASES OF THE MALE ORGANS OF GENERATION. 479 

bladder ; stools are flattened like a ribbon ; constipation ; a 
feeling as if the bowels were not perfectly evacuated. The 
frequent calls to make water become a serious item, disturbs 
the patient at night, and interferes with his comfort during the 
day. Continence or incontinence is likely to take place ; if the 
latter, the urine dribbles away. As the case progresses, there 
is more irritation of the bladder, urinary misery becomes 
greater, and fits of retention may take place from the slightest 
exposure to cold, or excess. The reflex symptoms are often 
distressing, — languor, lassitude, debility, nervous prostration, 
derangement of spinal cord, brain, stomach, liver, and espe- 
cially in young patient, a morbid condition of the mind. 

With all these and other symptoms, there should be an exam- 
ination per rectum with the forefinger of right hand, and in all 
cases the gland can be felt, large, hot, tender. The examination 
should be made with patient on his back, finger-nail filled with 
soap, and the finger, well oiled, should be introduced very slowly 
and gently, so as not to excite spasm of the sphincter. 

Treatment. — As soon as the disease is clearly made out, and 
the necessary arrangements made, begin w T ith a general vege- 
table alterative and tonic course, as ozonized phytolacca and 
iodide potass, ozone-water, glycerite of ozone, gentian, columbo, 
or some other better tonic. 

Instruct patient that cure is slow, but positive, unless very 
old. Inculcate good diet ; attend to skin ; daily bathing and 
flannel clothing ; bowels to be opened daily ; a cold water hip- 
bath, morning and night, for fifteen minutes each time; forbid 
tea, coffee, tobacco, and all kinds of alcoholic drinks ; recom- 
mend exercise, an avoidance of unhealthy literature, and for a 
few months at least, a suspension of sexual congress. Patient 
should sleep on hair mattress, on his right side. While this 
treatment is being carried out, the special features of the case 
should be attended to. 

To Arrest, Check, or Control the Morbid Sexual Desire, or Emis- 
sions. — Try first thirty drops of tincture of green root gelsemium 
at bedtime, and increase dose if necessary. Or tincture digitalis, 
drops eight. Or tincture belladonna, drops five ; begin in after- 
noon, and give three doses before bedtime. Or tincture ery- 
throxylon coca in sufficient doses. Or lupulin and lactucarium. 
Or, best of all, the spermatorrhoea pill. The salts of bromine 
are efficient, and, if used, let it be for a little while. 

To Promote Absorption of Effused' Lymph in Prostate. — The 
patient is on iodide potass in his alterative ; so, to aid its action, 
try every night at bedtime a few grains of powdered mandrake, 
blue flag, and cream of tartar. Or infusion of hydrangea ; or 
cleavers ; or uva ursi. Or muriatic acid in five-drop doses, thrice 



480 DISEASES OF THE MALE ORGANS OF GENERATION. 

daily, in water ; and, in addition to either, a suppository of bella- 
donna and iodide of potassa. 

To Overcome Inflammation of Prostatic Portion of Urethra. — 
The utility of the application of the solid sticks of nitrate of 
silver in paste caustic, every two or three weeks, cannot be 
controverted. 

For Retention of Urine. — The ordinary means, warm hip-bath - 
bath, belladonna suppositories, and gelsemium internally, fail- 
ing, urine should be drawn off daily with a catheter. This is 
a good plan if there is the least inability to empty the bladder 
completely, as it is of primary importance that at least once in 
the twenty-four hours the bladder should be thoroughly emp- 
tied. If this is not attended to, it may bring about paralysis 
of the organ, with the loss of the power of voluntary micturi-'* 
tion, and cystitis. For this purpose, a No. 12 silver catheter is 
better than a smaller instrument ; it goes in easier, is less likely 
to do damage. Keep the point of the instrument on the upper 
wall of urethra, and, above all things, use no force. In a short 
time, even in old cases, the patient will be able to get along. 
An alterative and tonic course should be persevered in. 

PROSTATORRHCEA. 

This may be defined as an excessive secretion, of a clear, 
viscous, tenacious fluid, like the white of an egg. entirely desti- 
tute of spermatozoa. 

The causes of this catarrhal condition of the prostate gland, 
are, masturbation, withdrawing the penis in the act of ejacula- 
tion, having congress with women affected with leucorrhcea, or 
with those whose vagina is large, relaxed, or lost its tonicity ; 
or 'often a result of chronic inflammation, badly -treated gon- 
orrhoea. 

Symptoms. — These consist in the discharge of a few drops 
of a ropy, viscid mucus from the urethra after micturition and 
defecation. The escape causes great alarm, as the patient be- 
lieves he is suffering from a loss of semen, whereas it contains 
no spermal elements. Still, the frequency and persistency of 
the moisture, the slimy urethral discharge at stool, exercises an 
irreparable bodily and mental injury to countless thousands. 
True, the involuntary emission of semen is often associated with 
it, but catarrh of the prostate often exists without there being 
a particle of semen in it. In catarrhal inflammation of the 
tubular glands of the prostate there may be some tenderness, 
frequent micturition, and loss of sexual power. 

In making a correct diagnosis of this affection, we must bear 
in mind that the normal function of the prostate is to furnish 
an alkaline fluid in which the spermatozoa may float, and, like 
the sexual apparatus, is kept in a healthy condition by a normal 



DISEASES OF THE MALE ORGANS OF GENERATION. 481 

co-ordination of the nerve-centres. The proper secretion of all 
glands depend on a healthy nervous system. If the centre 
is perverted, the circulation of blood through the prostate is 
vitiated. The seat of sexual desire is in the base of the brain. 
The nerve-centre for the sexual organs is situated in the lumbar 
enlargement of the spinal cord. If those centres are entire, 
the sexual secretory function is perfect; but when sexual glands 
discharge their peculiar secretion into a common emunctory 
or outlet, it is difficult without microscopical aid to distinguish 
whether they are simple or compound. 

In prostatorrhce there is no semen ; no loss of that brain 
secretion, which is intrinsically the most valuable fluid in the 
body — life itself; one ounce of which is richer by far than forty 
ounces of arterial blood, the loss of which in chronic prostatitis 
and spermatorrhoea enervates, whittles down, produces prema- 
ture decay, lost manhood, fills the lunatic asylums, gives rise to 
suicidal mania. 

In the white, slimy, glairy, tenacious catarrhal discharge of the 
prostate there is no semen. 

Treatment. — Same as for spermatorrhoea and chronic pros- 
tatitis. 

In addition r a very free use of the fluid extract sumbul and 
erythroxylon coca, which exercises a most remarkable sedative 
influence over the motor, sexual, and urinary centre in the 
spinal cord. 

CANCER OF THE PENIS. 

Malignant disease of the male organ ; may be met with in 
the epithelial, medullary, and scirrhus form. It is more fre- 
quently caused by contact with an affected female than other- 
wise. It may begin on prepuce or extremity of the penis. 
As the structure of the organ is of very high organization, 
destructive ulceration is rapid. Lymphatics on the dorsum of 
the penis and in the groin become early involved, and the 
cancerous cachexia is thoroughly established. 

The usual treatment for cancer must be carried out with 
persistency and activity. 

INFLAMMATION OF THE TESTICLES, OR TESTITIS. 

The testes are so called, from testis, a witness, a testimony of 
virility; a gland for secreting spermatozoa from the brain. They 
are liable to suffer a partial death from a variety of causes : 

(1.) Acute Testitis, or Orchitis, or Swelled testicle, may be 
caused by blows, kicks, falls, or violent exercise, or badly-fitting 
clothing ; by a metastasis, or extension of gonorrhoeal inflamma- 
tion from the urethra ; such inflammation having been shifted 
or moved by the use of such drugs as balsam copaiba, turpen- 

'43 



482 DISEASES OF THE MALE ORGANS OF GENERATION. 

tine, cubebs, kava kava, or aggravated by strong irritating in- 
jections, or alcohol, or venereal excesses. In some cases, only 
a portion of the testicle is affected, such as its body; or the 
epididymis and tunica vaginalis are attacked, or the entire 
gland suffers. 

Symptoms. — Pain, and feeling of weight in cord and testicle ; 
great uneasiness in the loin, groin, and upper part of thigh ; 
frequent micturition; diminution or suppression of the urethral 
discharge; swelling of the epididymis, which embraces and 
hides the testicle; scrotum firm and tense; swelling of the cord; 
great tenderness; pressure aggravates the pain. There is pain 
in the head, back, calves of legs; rigors, and a fever; nausea, 
vomiting, constipation. The inflammation, if violent, powers 
of life feeble, or inefficiently managed or treated, may terminate 
in chronic inflammation, with effusion of lymph, induration 
and enlargement, or abscess; or, if vital force is greatly de- 
pressed, and system vitiated with mercury and syphilitic germs, 
gangrene. 

Treatment,— As there is nausea and often vomiting, with a 
depraved condition of the alimentary canal, an emetic of lobe- 
lia, followed by warm or alcoholic vapor-bath ; then open bowels 
freely with salines ; administer aconite, veratrum and gelsemin, 
freely and frequently, till pulse reaches seventy, then in small 
doses at longer intervals ; opium and Do vers powder, to relieve 
pain; apply, in the form of packs, several layers of canton 
flannel, embracing the entire scrotum, saturated with the fol- 
lowing: water, one quart; muriate of ammonia, half a pound; 
nitrate of potash, quarter of a pound ; common salt, a handful ; 
tincture of iodine, one ounce. Mix; cover with oiled silk, and 
moisten again and again. If skin of scrotum becomes tender 
or sore, or excoriated, keep it off a few hours, and apply cloths 
wet with hot water and opium. Bowels to be kept freely opened ; 
patient must be confined to his bed ; diet as for fever. Just as 
soon as the active stage is controlled, place patient upon iodide 
of potassa in a vegetable alterative, followed by tonics. If the 
inflammation of the testis be due to the sudden suppression of 
a gonorrhceal discharge, it is unquestionably a good plan to 
inject the urethra, once or twice, with a solution of the sesqui- 
carbonate of potass, so as to cause the gonorrhoea to re-appear ; 
it has the effect of removing the inflammation from, the testis 
at once. In bad cases, powers of life low, and ignorance of 
medical attendant gross, where the inflammation has been mal- 
treated, the testicle enormously swollen and very painful, it is 
found to be a good plan to puncture the body of the testis, so 
that by a division of the tunica albuginea, the pressure on lob- 
ules and convoluted tubes may be removed. The incision allows 
a quantity of serum, lymph, and blood to escape, and affords 



DISEASES OF THE MALE ORGANS OF GENERATION. 483 

instant relief in such cases. After such, some resort to com- 
pression with adhesive strips, but this is very painful, and the 
best plan is to apply the hot water and opium. After recovery, 
patient should wear a suspensory bandage for a few months. 

(2.) Chronic Testitis. — In this we have a low grade of irri- 
tation, with a large quantity of lymph effused, which gives 
rise to very great enlargement and induration, the testis becom- 
ing, in some cases, enormously increased in size. 

Causes. — It may be a sequel of an acute attack when badly 
managed, but more generally it is due to a low grade of irrita- 
tion, as horseback exercise, imperfect coition, strains, condoms, 
stricture, gleet, or the presence of the s} T philitic germ in testis. 

Symptoms. — Testicle hard and swollen ; slightly painful to 
pressure, but very weighty ; the irritation and effusion of lymph 
usually begins in the epididymis, and extends to the body of 
the testicle ; sometimes effusion of serum takes place into the 
tunica vaginalis. The s} T philitic form is usually accompanied 
with indications of the presence of that germ elsewhere, as on 
the tongue, throat, skin, bones or iritis. 

Treatment. — Pretty nearly the same as for the acute; bowels 
open; use of same lotion; iodide of potass internally. Here, 
if the cause can be ascertained, remove it, It is well to look for 
stricture, or masturbation, or impediment to sexual congress. 

If case does not yield, try ozonized clay, at night, around 
entire scrotum, or several times a week ; during the day, apply 
belladonna ointment and iodide of potass, or ointment of iodide 
of cadmium, or iodoform ointment; wear suspensory regular; 
and internally, ozonized phytolacca, ozonized glycerine, and 
iodide and bromide of potass. In cases of great enlargement, 
with induration like a stone, it will yield to the above if per- 
severed with. 

(3.) Abscess and Fungus of Testicle. — This may follow 
acute or chronic inflammation, if effusion of lymph has taken 
place in any quantity. The appearance of rigors; the pain 
changing to a throbbing pain ; a sense or feeling of fluctuation ; 
when those symptoms are detected, the tissue becomes adherent, 
and nature makes an effort to evacuate the pus through an 
opening made by the inflammatory action. When the skin 
and other integuments give way in this manner, there is no 
need of any surgical proceeding. If nature is slow or tardy, 
then she must be aided by hot poultices and a puncture. Pres- 
sure being applied after the pus has been evacuated. Either 
after spontaneous opening or otherwise, a protrusion of fibro- 
plastic matter with some of the tubular structure of the testicle 
is liable to take place. If not watched, kept in its place and 
strapped, this tubular protrusion or fungus slowly increases, so 
that it must be returned and kept in its place. If the pro- 



W^^M 



484 DISEASES OF THE MALE ORGANS OF GENERATION. 

traded part has become disorganized, it must, however, be 
sliced off, a proceeding equivalent to partial castration. After 
all the lymph has been evacuated and healed up, there may 
exist an adhesion between the covering of testicle and the in- 
ternal lining membrane of the scrotum ; if so, if detected early, 
it can be pulled asunder by grasping the testicle firmly, and 
pulling the scrotum apart from it. If it does not yield easily, 
divide by incision. 

In all cases, patient should be kept on alteratives and tonics, 
and wear a suspensory bandage for some months. 

(4.) Tubercular Testes. — A weakened condition of the tes- 
ticles from any cause serious enough to relax and permit of effu- 
sion of the tubercular germ into the tubuli seminiferi, or into 
the epididymis, may give rise to an immense growth of these 
germs in this structure. Indeed, the testes are to be regarded 
as a favored pasture field for all diseased germs in the blood. 

Symptoms. — There are few of the indications of inflamma- 
tion ; no pain or tenderness, but testicle becomes nodular, and 
does not increase much in size; still, without apparent irrita- 
tion, the tubercle grows ; undergoes its various forms of death, 
milky, cheesy, calcareous ; softening and suppuration take place ; 
the swelling bursts ; pus and tubercular matter conies away ; 
sinuses form, and other infiltrations may break down. The 
sores may heal, or there may be a protrusion of tubular struc- 
ture — the fungus of the testicle. The tubercular diathesis is 
usually well marked. 

Treatment. — The same constitutional treatment as laid down 
under tuberculosis, administering ozonized glycerine and water 
steadily. The application of the ozonized clay, every night, 
over the entire scrotum, if skin does not become too tender, 
soon destroys the germ ; and during the day, ozone ointment 
or lime-water and tincture of iodine could be kept applied, with 
suspensory. 

(5.) — Other germs irritating testicles, as the germs of syphilis, 
mumps, scarlatina, etc., the treatment to be carried out on gen- 
eral principles. 

NEURALGIA OF THE TESTIS. 

The nerves of the testicle are often exhausted by venereal 
excesses ; suffer anaemia or starvation ; often poisoned by im- 
pure blood, as in syphilis, gout, rheumatism, etc. ; or the ejac- 
ulatory ducts become clogged or stopped up, giving no outlet 
for the secreted semen ; the testes suffer ; their covering or tunic 
is stretched, and they are compressed ; and we have their nerves 
crying for richer and purer blood, and freedom from compres- 
sion. 

Neuralgia. — This condition of nerve-starvation or nerve- 



DISEASES OF THE MALE ORGANS OF GENERATION. 485 

poisoning, in its ulterior results, leads to atrophy of the testicle. 
Our best remedies are rest ; a most generous nerve-manufac- 
turing diet, as animal food, white-fish boiled, oatmeal mush, 
corn bread ; external warmth to scrotum ; relieve pain by opium 
and belladonna suppositories, hyosciamus and opium ; adminis- 
ter internally quinine, cinchona and mineral acids, ozone water, 
glycerite of ozone. If there is a syphilitic taint, or rheumatic 
or gouty diathesis, special remedies to meet such. General tonics 
and alteratives if cause is obscure. 

ATROPHY AND HYPERTROPHY OF TESTICLE. 

Wasting of the testicle is due to excessive venery, masturba- 
tion, germs of syphilis, neuralgia, varicocele and circocele,. tight 
capsular coverings, irritation, hematocele. 

Blows, shocks on back of head or spine, as well as excessive 
grief, sorrow or suffering, may produce wasting of the testis. 

It should be treated with alteratives and tonics ; removal of 
cause, and local stimulants and brain food. 

Enlargement without effusion of lymph is rare ; still it may take 
place from excess, masturbation, having congress with women 
with very roomy or dilatable vaginas, and other forms of irri- 
tation. Increase in size is often due to obstruction of the sem- 
inal or ejaculatory ducts. 

VARICOCELE. 

A varicose condition of the veins of the spermatic cord. 

Causes. — The predisposing cause is one of essential debility, 
and may arise from any cause which retards the upward flow 
of blood, as sexual excesses, masturbation, straining, standing, 
tumors, hernia, trusses, obesity. Ac the left side is weakest, 
the veins on that side the longest, they afford a better chance 
for obstruction, and are those specially affected. 

Symptoms. — A pyriform swelling, with base on testis, which 
diminishes or disappears when patient lies down ; has a slight 
impulse on conghing, but always feels like a bag of worms ; 
besides, there is weight ; aching about groin and loin ; a good 
deal of uneasiness or pain about scrotum ; neuralgia of testicle ; 
and, if not cured, leads to entire wasting of that important 
gland. Mental depression is a prominent feature in the case. 

Treatment. — The removal of cause or causes ; a regular ac- 
tion of bowels to be insured by proper diet. Every possible 
means taken to improve general health, with nourishing food, 
baths, and proper clothing. A cold water hip-bath morning 
and night; a suspensory bandage to be worn, one that will 
give proper support. The internal remedies should consist 
chiefly of tonics, such as cinchona compound and mineral 
acids ; a pill of quinine, hydrastin, iron and nux ; gentian and 



486 DISEASES OF THE MALE ORGANS OF GENERATION. 

mix vomica, and extract of hamamelis or hazeline. This latter 
remedy in lotion is our best local application. Rigid persever- 
ance will effect a cure. 

The obliteration of veins by silver or iron-wire ligatures, or 
hair-lip pins, or dividing veins in any way, is never free from 
danger. 

Circocele. — A varicose condition of the veins of the testicle. 
Common cause, masturbation and syphilitic disease. Should 
be treated same as varicocele, and an alterative and tonic course 
pursued for some months. 

SCROTAL EFFUSIONS. 

The various diseases of the testes are liable to give rise to 
effusion of serum from the tunica vaginalis, and thus give rise 
to an accumulation of water in the scrotum, called hydrocele; 
whereas injuries, as falls, kicks, give rise to extravasation of 
blood, or hematocele. 

(1.) Hydrocele of Tunica Vaginalis. — Dropsy of the scro- 
tum may be a result of inflammation, or disease, as enlargement 
of testis injuries, or dependent on general dropsy. 

Symptoms. — The scrotum becomes gradually distended with 
serum, which forms a smooth, pear-shaped, elastic, and trans- 
lucent swelling. The spermatic cord can usually be detected 
free at its neck, and the testicles can be detected lower down. 
There is no impulse on coughing. To take patient into a dark 
room, and hold the scrotum between you and a lighted candle, 
is an absurd proceeding ; for the serum in the scrotum is often 
grumous, turbid, and it may not be transparent, although in a 
good number of cases it is of a pale straw-color. In quantity, it 
averages about twelve ounces, less or more. If it is allowed to 
become chronic, it may lose its pear shape, become thick, and 
almost invariably opaque. In some cases, instead of the water 
being in one mass or volume in the scrotum, it is found in 
cysts, resembling a honeycomb ; it is then called encysted. Little 
boys may be born with this accumulation, and the communica- 
tion between the peritoneal cavity and scrotum may not have 
been obliterated ; it is called congenital. 

Treatment. — In the early stages or in acute form, such as in 
scarlet fever or from testitis, try treatment for dropsy — diapho- 
retics, diuretics, hydragogue cathartics, preceded with digitalis, 
then iodide potass, and back on those remedies (see Dropsy), 
using the lotion of muriate of ammonia over scrotum. If 
medicinal means fail, then tap the scrotum about three-fourths 
of an inch from the median line at the base, boring gently in 
with trocar and canula until the serum appears between the 
fingers; then withdraw the trocar, leaving the canula in, 
through which the fluid oozes out. After it has been entirely 



DISEASES OF THE MALE ORGANS OF GENERATION. 487 

drained away, insert the trocar again, and push it through the 
walls of the scrotum high up. After perforating, withdraw the 
trocar, and insert up through the canula a strand of seven 
threads of saddler's silk, and holding the upper end, withdraw 
the canula, and then tie the ends of the strand together; undo 
this knot every morning, and remove one thread every suc- 
cessive day till they are all withdrawn. By this method the 
secreting faculty of tunica vaginalis will be destroyed, and a 
perfect cure is the result. There is no deceiving the patient 
with this manner of dealing with the case, as the result is 
always most satisfactory. Some tap without using the seton ; 
others tap, withdraw the fluid, and inject tincture of iodine; 
while another class aspirate ; all such measures are uncertain 
and inappropriate. 

In the encysted form each sack must be punctured, one by 
one, and their contents drained off, and then the seton. In 
the congenital form a truss must be worn, so as to irritate a 
little, and thus close up the vaginal process. Usually the 
muriate of ammonia lotion to scrotum is sufficient. 

(2.) Hydrocele of Cord. — It is rare to find serum accumu- 
lating in the areolar tissue of the cord ; if it does occur it is 
apt to be in distinct cyst. If medical treatment is necessary, 
our best remedies are alteratives and muriate of ammonia 
lotion. 

(3.) Haematocele. — Is usually the result of injury or violent 
inflammation. The haemorrhage or effusion of blood fills up the 
tunica vaginalis in some cases so as to cause compression of the 
testicle, and thus produce atrophy. Rest, use of absorbents, as 
iodide potass, with the use of muriate of ammonia and tincture 
iodine lotions, will often effect absorption. If it does not, the 
scrotum should be opened at its most depending part, and the 
coagulated blood permitted to escape. 

(4.) Scrotal (Edema. — Is very apt to be present in anasarca 
of scarlet fever, or Bright's disease ; in measles, erysipelas, vari- 
ola; the areolar tissue becomes infiltrated, sometimes in itself 
produces violent constitutional disturbance, and gives rise to 
sloughing or phagedena. Muriate of ammonia lotion, atten- 
tion to skin, kidneys, bowels, and, if sloughing threatens, local 
and internal antiseptics, tonics, best of nourishment. 

(5.) Phagedaena of Scrotum. — In highly tubercular sub- 
jects, subjected to some depressing influences or irritation, 
phagedaena, or gangrene, will suddenly set in, without any 
prior inflammation, or haematocele, or venereal disease, and in 
spite of best local and internal antiseptics, destroy the scrotum 
clear to the pubes. 

Most nourishing support, local and internal antiseptics to 
destroy the germ oidium albicans. 



488 DISEASES OF THE MALE ORGANS OF GENERATION. 

(6). Scrotal Elephantiasis. — Enormous hypertrophy of the 
scrotum, so great that it often reaches between the knees. 

The sebaceous glands, from a few up to a great number, often 
become filled up with cheesy or sebaceous matter. If ozonized 
clay does not act as a solvent, they have to be opened one by 
one, and contents and cyst removed. Mucous tubercles are 
common on scrotum in syphilitic contamination. Sprinkling 
with calomel is the best remedy. 

SPERMATORRHOEA. 

A deranged state of bodily and mental health, due to the 
flowing or oozing away of semen. The causes are numerous, 
but masturbation, or Onanism, is the most common cause. 

Masturbation, or Self-abuse, is a name applied to a pernicious 
and destructive habit — the stimulating of the penis with the 
hand, in order to excite a discharge of semen; an act revolting 
to humanity, and destructive to a vigorous manhood ; an act 
that depreciates the vital stamina, dwarfs and whittles down 
manhood, entails degeneration, disease, insanity, and death on 
the individual. 

The more marked effects of masturbation are its irritating 
effects upon the prostate gland, causing inflammation by the 
act, and retention of semen in the ejaculatory ducts ; the veins 
of the cord and testicle also suffer, become weak, and varicose; 
atrophy, or wasting of testicle, likely to take place ; and if the 
practice has been commenced in early life, they do not attain 
their full size, lose their power of secreting semen ; and asso- 
ciated with these conditions, the entire body is dwarfed and 
robbed of its vital elements — life itself. 

True, the generative organs suffer most. The penis and tes- 
ticles resemble those of a boy, take on interstitial absorption, 
lose their elasticity and firmness, become almost bloodless, the 
spermatic cord atrophies, the nerves degenerate, and the cre- 
master muscle disappears. The thin, watery semen that is 
formed under such a state is entirely destitute of spermatic 
granules and spermatozoa; its fertilizing power is lost, and 
impotency supervenes. 

When the testicles waste away, as the result of masturbation, 
the wasting is equal, degenerating to nothing ; whereas in atro- 
phy, the result of systemic syphilis, they alter in shape, become 
uneven or irregular, or elongated as well as small. 

Instead of that diminution in size, the testicles may enlarge, 
puff up, insidiously increase in bulk, but diminish in firmness, 
consistency, and elasticity ; in other words, they become spongy. 
Whether it be enlargement or atrophy, it is always to be re- 
garded as the percursor of decay. 

The intimate relationship of the brain and spinal cord, the 



DISEASES OF THE MALE ORGANS OF GENERATION. 489 

nervo-vital fluid, and the secretion of the semen or spermatozoa 
from that, intrinsically the most valuable tissue in the body, 
render a perfect harmony and adaptability between the organs 
and brain indispensable. 

It is the delicate and impressible nervous system of the young 
of both sexes that experience the depressing effects, the fearful 
ravages of self-abuse the most. It strikes at the root of society, 
the origin of our species, dwarfing its very form and features ; 
stunting growth, and creating tubercular and innumerable 
diseases; enervating and debilitating every tissue. The ten- 
dency of the present age in developing the nervous system of 
our people at the expense of the physical, the moral tone of 
society blunted, the character of a large amount of literature, 
and the lowering tendency of modern amusements, and other 
conditions, have their effect in creating this abnormal desire. 
Fathers and mothers must not shut their eyes to the fact, that 
children at a very early age often resort to tickling the genera- 
tive organs. It too frequently happens just at a time when all 
the energies of nature are needed for development. The most 
critical period of life is about and after puberty. The change that 
takes place, the rapid growth of the organs, the increased power 
and frequency of erection, the development of a new life, and 
other states, imperatively demand that the young man should 
be surrounded with pure, moral atmosphere; should on no 
account suffer from isolation or monotony — two of the worst 
elements in its production. 

The time at which young persons become addicted to this 
habit is one of the most critical periods of life — usually about 
puberty. The generative propensity, called forth prematurely 
and viciously gratified, steps in amidst the natural efforts of 
growth, with its unnatural train of nervous shocks and physi- 
cal pollutions, causing our boys and girls to have the appear- 
ance of old age, being feeble, pale, imbecile, effeminate; having 
a distaste for everything, incapacitated for enjoyments, mere 
wrecks of humanity, being victims of chorea, epilepsy, paralysis ; 
in other words, they are committing a lingering moral and 
physical suicide. 

Change, diversity of scene, an avoidance of monotony or 
sameness, no isolation of sexes, never solitary or alone, are essen- 
tial to high health and longevity. Isolation, or monotony, 
wipes out the convolutions of the human brain, renders its 
victim an irresponsible being, but in nearly every instance a 
masturbator. If you desire evidence, take the inmates of our 
prisons, refuges, asylums, homes, boarding-schools. Isolation 
of the sexes has a highly detrimental effect in producing the 
typical brain convolutions of the Onanist. 

Man is the abject slave of habit, hence the difficulty of aban- 



490 DISEASES OF THE MALE ORGANS OF GENERATION. 

doning the habit of masturbation when once indulged in. Often 
the patient is unconscious for years of any change, and no part 
of the body feels weaker than another ; but surely, though it 
may be slowly and insidiously, a creeping langour, lassitude, 
and debility comes on ; a want of energy, a depression of spirits, 
a disinclination to society; these feelings gradually increase 
until they attract the attention of the victim. His face becomes 
pallid ; his back and knees weak ; he sees specks or spots before 
his eyes ; his hands and feet are cold and clammy ; the circles 
around his eyes are depressed and darkened; he becoms emaci- 
ated ; he cannot bear the cold as formerly ; his old pursuits and 
amusements have no attraction, nor new ones a charm for him ; 
his memory becomes imperfect ; his eyes become weakened ; 
morbid sensations annoy him ; the freshness and plumpness of 
complexion disappear ; a leanness or wasting of tissues succeeds ; 
the skin becomes rough, often of a leaden hue ; the eyes lose their 
brilliancy, and by languor express that of the whole frame ; the 
lips lose their vermilion tint; the teeth their whiteness; the 
hair becomes dry and falls out, and sometimes even the whole 
body is bent and distorted ; his face is shrunken, haggard, pale, 
unmeaning, and unexpressive ; his eyes dull, and lacklustre. 

The evils of this practice are not alone confined to the male 
sex, but are equally common among young women, especially 
those of a religious turn of mind in the higher circles of society. 
Young and apparently modest ladies are dying by thousands 
from consumption, female complaints, spinal and nervous irri- 
tation, general debility, and other obscure diseases, caused by 
masturbation. The effect on the female is similar to that in 
the male. The practice causes a glairy discharge, very weaken- 
ing, also leucorrhcea, and ovarian irritation, mental abberation, 
suppression of the menses, and general disorganization of the 
econom}^. 

Hence the stimulus arising from distension of these vesicles 
becomes a pleasurable impulse to the necessary multiplication 
of the species ; and if sexual desire were susceptible of gratifica- 
tion only as the result of instinct, if depraved man, instead of 
exhausting his generative organs by reading trashy novels or 
impure literature, filthy conversation, lewd and lascivious ima- 
ginings, and such like, which are entirely absent in the lower 
animals ; if, like them, he were content to follow the dictates of 
his unerring organization, diseases arising from excess would 
be unknown, equally among us as with them, and the integrity 
of the human stock be improved beyond even the most vivid 
imagination. As the seminal vesicles will not allow of extraor- 
dinary distension, the thinner portion of the semen becomes 
absorbed, and thereby the bulk of the secretion is diminished; 
yet the residue becomes more acrid and stimulating, the impulse 



DISEASES OF THE MALE ORGANS OF GENERATION. 491 

to excretion is almost rendered unconquerable, and so nature 
occasionally relieves herself of the superabundant secretion. 
Of this act, men are mostly unconscious ; if, however, it arrests 
attention, its frequency and its consequences are the circum- 
stances that arouse the proper and natural fears of the sufferer. 

The effects of masturbation are not confined or limited to 
the sexual organs, to wasting or atrophy of spermatic cord, 
testicles, and spinal cord, but reacts chiefly upon the brain, in 
creating the most inveterate form of tuberculosis ; a diathesis 
which in itself intensifies sexual desire, added to which our 
literature of the baser sort is pre-eminently demoralizing, the 
moral atmosphere is tainted. 

The constant drain and irritation impoverishes the spinal 
cord and brain, and tells upon the whole bod # y ; the semen of 
a person so affected becomes thin, watery, of a sickly odor, no 
spermatozoa in it, consequently not fertilizing; and even if 
slightly so, the offspring would not be likely to survive. 

The effects produced by masturbation maybe embraced under 
three heads : 

(1.) A simple condition of relaxation or debility, in which 
the seminal ducts will not retain the semen, or else a condition 
of chronic prostatitis, with emissions often and persistent. 

(2.) Chronic inflammation of the lower portion of spinal card. 

(3.) Exhaustion and irritation of the brain. 

The leading or characteristic symptoms of those three stages 
are as follows : A general feeling of languor, lassitude, debility, 
there is vertigo or swimming in the head ; specks or spots before 
the eyes ; noises in the ears ; skin becomes white ; pupils are 
dilated ; breath fetid ; digestion is feeble ; bowels constipated ; 
the faeces harden in the rectum, and produce irritation of the 
seminal ducts in their vicinity ; the circulation is languid ; the 
extremities cold and clammy ; the muscles soft and flabby ; 
by-and-by, the forehead may be dotted over with pimples ; the 
corners of the mouth are lengthened ; the nose and features 
become sharp ; eyes sunken and deprived of their brilliancy ; 
there are bluish circles around them ; no look of gaiety or 
animation ; he cannot look }'ou in the face ; becomes morbidly 
sensitive ; loses all his vivacity or grit. 

The case progresses onwards ; there is weakness about loins 
and knees ; a crackling in the joints ; memory fails ; perceptions 
become dim; desires blunted; distraction or absence of mind, 
which renders him unfit for business ; imagination gives birth 
to the wildest fancies and most groundless fears ; an allusion 
to the habit, in his presence, causing a twitching, a flush of 
shame, or even despair. The affected one shuns the face of 
man, and dreads the observation of women ; then, after a while, 



492 DISEASES OF THE MALE ORGANS OF GENERATION. 

there are fainting fits, wandering pains, chorea or convulsions, 
tremblings, epilepsy, and partial paralysis. 

The debility of spermatorrhoea is both local and general, 
never partial. Persons so affected, in attempting sexual inter- 
course, may be unable to get an erection ; or, if the act is ac- 
complished, an emission takes place too quickly, and is followed 
by exhaustion ; besides, there are daily as well as nocturnal 
losses; the semen regurgitates, and finds its way into the blad- 
der, and is passed in the urine ; or it may be passed during an 
evacuation of the bowels ; the patient becomes keenly alive to 
his weakness; is timid, fearful, careless of everything; his 
mind becomes absorbed in the consideration of his malady, 
until the presence, recurrence and persistence of the same train 
of thought, with the ever-leaking seminal ducts, creates a mon- 
omania or premature old age. There is not a gland or function 
nor movement of the body natural, nor a faculty or organ, nor 
sense or perception of the brain clear or healthy ; all is out of 
gear; nothing but disintegration and disease; with all, through 
by all night and day, the seminal fluid or brain juice oozing, 
dribbling away without sensation, erections, or any show of 
natural ejaculation. This persistent drain of the most vital 
fluid in the body varies in quantity, according to the state of 
weakness. 

Although the brain and cord exhibit great damage, and even 
molecular death, still, there is not an organ in the entire body 
that is not seriously affected. We hear it in his squeaky voice ; 
in the palpitation of the heart ; in his difficult, often suffocated, 
breathing ; besides, his or her stomach is deranged ; appetite 
craves strange articles ; there is indigestion ; prostration of ner- 
vous system by day; unrefreshing sleep at night. The emis- 
sions on some have a fearful, prostrating effect, those by night 
being exhausting, and those by day, at stool or in urine, or in 
a continual oozing and dampness, even still more enervating. 

Then, briefly to recapitulate : 

Spermatorrhoea is a draining or oozing away of the vital fluid, 
a loss of an essential principle of life ; or, in other words, a 
state of nervous exhaustion, brought about by masturbation, 
which is an irritant to the sexual apparatus, which irritation, 
as well as drain, implicates both cord and brain, often giving 
rise to organic lesions ; with loss of memory ; impairment of 
senses ; loss of continuity of thought, with extreme debility ; 
the eye loses its lustre ; the aspect becomes cadaverous ; an in- 
ability to look a person in the eye ; a distaste for society ; a fear 
to meet women ; a love of solitude ; an atonic condition of the 
genital organs, followed by disorders of the kidneys, bladder, 
liver ; a depraved stomach ; weakened bowels ; disturbance of 
the heart; laryngeal and bronchial trouble; in short, the whole 



DISEASES OF THE MALE ORGANS OF GENERATION. 493 

body is injured by the indulgence in this solitary vice. An 
offensive odor is emitted from the person, resembling the smell 
of the ailantus blossom in a decayed state, or a dog-kennel. 
Its effects are many, causing obscure nervous disease, epilepsy, 
nervous exhaustion, impotence, sterility, softening, prostatitis, 
leucorrhcea, chorea, menstrual irregularities, imbecility, para- 
lysis, consumption, and death. 

From the above remarks it will be seen that spermatorrhoea, 
with its numerous complications of diseases, may be embraced 
under three distinct heads : 

(1.) The weakened or relaxed conditions of the organs of 
generation ; with prostatic disease ; atrophy or hypertrophy of 
testicle ; varicocele ; circocele ; oozing of semen, either by urine, 
stool, leakage, emissions or otherwise. 

(2.) Chronic inflammation or exhaustion of spinal cord. Its 
reflex nature causes it to be implicated early. 

(3.) Co-existant with the earliest dawn of loss of semen, the 
brain becomes devitalized, and remains persistently through 
the case, and needs recuperation or repair. 

Treatment. — In managing a case of spermatorrhoea, those 
three conditions should be borne in mind, and the treatment 
carried out accordingly. The patient must have the utmost 
faith in his medical adviser, that he has the abilities and rem- 
edies for a cure ; the patient must understand the deleterious 
influence of immoral or obscene literature, variety theatres, 
and other vices of depraved civilization, and shun them like a 
virulent poison. He must be careful of books or pamphlets of 
nefarious medical pretenders ; of bad company ; and he must 
be instructed as to the utility of religion and goodness on his 
moral nature and sexual vitality. 

The patient must have some bodily and mental work, and 
cheerful society. He should not sleep over seven hours, on a 
mattress, with light covering ; he must sleep on right side, never 
on back. He should eat nutritious food that is easily digested; 
avoid all alcoholic or malt liquors ; use no tobacco, tea or coffee ; 
he should, if possible, use a cold water hip-bath three times a 
day, carefully washing the glans penis, so as to remove all 
sebacious substances, and dry off gently ; and if the testicles 
are drooping, wear a suspensory during the day. If there are 
any hardened faeces or seat worms, use cold water injections 
into rectum morning and night. 

In addition to the above, daily bathing of the entire body, 
flannel clothing, with exercise in open air. 

Place patient at once on a general course of vegetable alter- 
atives and tonics ; the alteratives two hours after meals, and 
the tonics before meals, changing them weekly. Then at the 



494. DISEASES OF THE MALE ORGANS OF GENERATION. 

same time, special remedies to check emissions, relieve the irri- 
tation of cord, and reconstruct the brain. 

For Arresting the Emissions. — Use first the spermatorrhoea pill, 
which is a most efficacious remedy. As patient becomes habit- 
uated to their use, place him for a few days on tincture of green 
root gelsemium,infrom twenty to thirty-drop doses, beginning at 
eight o'clock, P. M., with first dose and another at bedtime. It 
has a most excellent effect in checking nocturnal and daily loses. 
Or erythroxylon coca can be used in same manner and dose as 
gelsemium. In some cases, tincture of digitalis in eight-drop 
doses operates well. Camphor, conium, and belladonna, lupu- 
lin and lactucarium, are also invaluable in some cases, in pretty 
large doses. 

As a rule, never give bromide of potass and ammonium ; 
they may arrest the emissions, but invariably, if long contin- 
ued, hasten or increase the atrophy of the testes, besides being 
irritating to the mucous membrane of the stomach. With some 
of the above, the leakages will undoubtedly be arrested, even in 
the most desperate cases, for the spermatorrhoea pills are almost 
infallible. Nocturnal losses in married men, where sexual 
congress is permitted once a week, dependent on debility, the 
general management of the case is the same, as regards baths, 
and injecting rectum with cold water, but a somewhat different 
line of conduct in checking the losses. Then compound tinc- 
ture of damiana, or tincture of nux vomica, cantharides, and 
erythoxylon coca, or tincture iron, with sulphate of alumina. 
If there is any failure, then have him sleep alone, and put him 
on the regular treatment, as above laid down. 

As soon as the emissions are positively arrested, and not 
before, the patient should be placed upon the glycerite of ozone, 
or ozone-water. Those are now our best drugs ; they vitalize 
the shattered brain, restore the lost memory, overcome debility ; 
they give tone and energy to the loose, flabby genital organs, 
steadying the action of the irritable heart, give expansion to 
the lungs, and remove that faltering, squeaky voice. Under 
their use the youth that has been prematurely old, becomes 
young, decrepitude disappears, the brain recovers its tone and 
vigor, the eye its lustre, the cheek its redness, the very joints 
are now lubricated, and the entire train of symptoms disappear. 

All through this patient has been upon alteratives and tonics. 

Those remedies are still to be administered ; but the tonics 
now will embrace cinchona and mineral acids, sulphate of 
quinine and aromatic sulphuric acid. 

The use of the glycerite of ozone entirely supersedes the 
compound hypophosphites of lime, soda, and iron ; it acts more 
promptly, the case recovering with more rapidity and per- 
manency. 



DISEASES OF THE MALE ORGANS OF GENERATION. 495 

As the cure progresses, give glycerite of kephaline ozonized, 
that brain and nerve food which nourishes the brain and nerves, 
by supplying the elements that have been lost by the emissions. 
In this way it restores the elements that have been drained 
away, which cause exhaustion, nervousness, loss of memory, 
paralysis, and other conditions of impaired vitality, besides the 
remedy is exhilerating nourishing, vitalizing. 

IMPOTENCE AND STERILITY. 

Impotence is a morbid condition in either sex, that prevents 
the spermatozoa of the male from coming in contact with the 
female ovule; in other words, it is an inability to consummate 
the sexual act. Sterility is a condition in which neither sperma- 
tozoa nor ovules are secreted, or elaborated ; or, if evolved, their 
vitality is immediately destroyed, or possess no fertilizing power 
whatever, — a perfect want of power to fecundate. 

(1.) Impotence in Man. — The act of copulation may be 
rendered inoperative by a variety of causes; such as by an 
absence of the penis ; or a want of growth, or development, or 
malformation, or mutilation of the organ. The dorsal, or upper 
aspect of the penis is covered with branches of sympathetic nerve, 
and its erectile power may be influenced by moral influences, 
as emotions, desires, affections, passions ; these may be simply 
over-excited, or violent, or dormant ; the man may have lost 
his confidence, through fear, or modesty, or anxiety or great 
love, or even disgust, and find it impossible to get an erection, the 
organ remaining flabby, like an old rag. It is to be naturally 
expected that disease, as in fevers, blood diseases, and general 
debility from any cause, would render the sexual organs feeble 
for some time. Injuries about the back of the head, blows, falls, 
and jars of childhood, as well as the concussions, shocks, of more 
mature life, as railroad accidents, — which are a great factor in 
its production ; heat of sun on back of head ; those are the most 
stubborn, as sexual desire is located and semen secreted in the 
brain. Again, injuries and disease of the spinal cord will 
abrogate the power to copulate, though the desire remains and 
semen may be secreted. Abuse of the sexual organs by mas- 
turbation, and by what is vulgarly known as tasting, destroys 
every vestige of erectile power. If persisted in, the function of 
erection may be forever lost. Congress with loose, lax, very 
large women, or those affected with leucorrhcea, or excessive 
sexual intercourse, will in time impair and remove the power 
of erection. Excessive obesity, large scrotal hernia, hydrocele, 
locomotor ataxia, and other diseases, will also prevent coition. 
Drugs, and the reckless abuse of some remedies, have a most 
deleterious effect on the sexual function. The excessive use of 
tobacco, which impairs digestion, weakens the nervous system, 



MMMHH 



496 DISEASES OF THE MALE ORGANS OF GENERATION. 

relaxes and whittles down the muscular tissue, renders a man 
feeble in procreative power, and ultimately saps his very vitals. 
Opium eating, or somking, or morphine and chloral using, 
dries up the very springs of life, prevents the elaboration of 
semen in the brain, and paralyzes the nerves that supply the 
erectile fibres. The long-continued use of digitalis in cardiac 
affections, tells most disastrously on the penis, in causing im- 
potency, as well as sterility. The long use of bromide of patass, 
on brain, spinal, and testicle, is equal to castration ; indeed, all 
acro-narcotics, as belladonna, conium, hyosciamus, veratrum, 
etc., are all detrimental to the vigor and good health of the 
sexual organs ; whisky is also highly deleterious. 

Treatment. — The most hopeless cases are those in which 
the brain and cord have suffered, as in injuries, thickening, 
locomotor ataxia, and the like ; or in some malformation, or 
mutilation, that cannot be rectified. 

As a general rule, remove all causes, as far as can be ascer- 
tained. Many very grave cases of deformity can be overcome, 
even the growth of the organ promoted, by electricity, and 
causing a vacuum around the organ daily, with a glass bell and 
air-pump, and other local stimulants. If it is due to a weak- 
ness of the sympathetic system, and fear of inability, let him 
stiffen up the action of his heart with digitalis, turn his back 
to* his companion, and wait, go to sleep, when probably early 
in the morning the difficulty will be overcome, and confidence 
restored. Disgust, or perfect incompatibility, often requires 
great tact and skill, but with good judgment and care he can 
be tided into the old rut, and all go well. If not, he must be 
placed upon the general treatment, which must embrace, daily 
bathing, with use of shower bath ; hip-bath ; cold water twice 
or three times a day ; bowels to be kept regular, and sleep on 
right side; the duration of sleep extended to eight or nine 
hours ; moderate exercise ; no mental work ; no care, or anx- 
iety, or study, or worry; avoid intense solar rays; positively 
forbid the use of tobacco, tea, coffee, whisky ; all acro-narcotics. 

Strongly recommend brain food, as oatmeal mush, boiled white- 
fish, corn bread, eggs, oysters, beef, mutton, poultr}^ game, milk, 
cream. 

See that digestion is perfect ; if not, add pepsin. 

An alterative and tonic course of remedies may always be 
prescribed with advantage, as having a tendency to improve 
the general health. Stimulating applications are often of utility 
to spine, in the form of plasters, friction, shampooing, elec- 
tricity. 

As to special remedies, phosphorus will naturally attract 
attention. It is not a good remedy as a medicine, as in every 
tobacco user it tends to create fatty degeneration ; crowd it in 



DISEASES OF THE MALE ORGANS OF GENERATION. 497 

the form of phosphatic food, boiled fresh mackeral, and oat- 
meal, but spare it as a drug. If used, administer it in the form 
of water of the sticks, or infusion by boiling the sticks, or in 
tincture, or in the form of salts of hypophospites of lime, soda, 
iron, in juice of meat. If tried, give invariably with a full 
meal, or after eating. 

The glycerite of keph aline ozonized, being the natural phos- 
phate from the ox brain, barley, oats, wheat, is a true nervo- 
vital essence, and can be administered with the best success. 

Our next best remedy is the compound tincture of damiana, 
the true tincture of damiana, with the other ingredients. 

Then mix vomica, cantharides, erythroxylon coca, and sum- 
bul , should have a trial. 

Cinchona and mineral acids, quinine and aromatic sulphuric 
acid, quinine, iron, and hydrastin, are our best tonics. 

(2.) Impotence in Woman. — May be due to want of devel- 
opment in uterus ; or malformation, as in vaginal occlusion, 
with an excessively-developed and ligamentous hymen ; oblit- 
eration of the vagina, a double vagina, or a regular vagina 
without a uterus, or, if the latter exists, it is so small that it is 
of no practical utility; vaginismus, a super-sensitiveness of the 
surrounding tissues of the vagina, involving its sphincter mus- 
cle so as to form a complete barrier to coition ; tumors of vagina, 
uterus, ovaries, which mechanically prevent copulation. Uterine 
cancer does not in all cases cause impotency. The same causes 
that exist in men, — disease of brain, spine, blood, and the use 
of snuff, or tobacco, opium, chloral, belladonna, conium, and 
whisky, — render some women callous, and often impotent. The 
want of ardency, or callousness, or the icicle coldness of some 
women, is not always to be attributed to impotency, but rather 
to incompatibility. 

Treatment of impotency in women is to be carried out by a 
removal of cause, or causes, if practicable; many malformations 
can be rectified, as occlusion, tumors, and super-sensitiveness 

Then enforce pretty nearly the same course of bathing, diet, 
and remedies, as in males. 

(3.) Sterility in Man. — An inability to procreate, or produce 
offspring. The power of procreation may be lost by disease of 
the brain or spinal cord, by tuberculosis, diabetes, albuminuria, 
some defect in the co-ordinating chemical faculty, owing to 
which the functions of the testicles have not been called into 
play. Locomotor ataxia, diseases of testicles, inflammation, 
induration, abscess, atrophy and hypertrophy, tumors, syphilitic 
sarcocele, cancer, varicocele, and circocele ; obstruction of the 
excretory duct of testicle, such as temporary or permanent 
obstruction after epididymitis, power of copulating being good, 
but the ejaculated fluid being destitute of spermatozoa ; oblit- 

44 



498 DISEASES OF THE MALE ORGANS OF GENERATION. 

eration of ejaculatory canals from inflammation, hypertrophy, 
calcareous degeneration of prostate, or from lithotomy ; imped- 
iments to the escape of semen, as stricture of the urethra, 
where ejaculated spermatozoa regurgitate into the bladder; 
abnormal openings in urethra, or urinary fistula, so that semen 
fails to be thrown up into the vagina ; undescended testicles, 
that is, those organs being retained in abdominal cavity ; copu- 
lation being feasible, but the semen, as a rule, is destitute of 
spermatozoa. Abuse of tobacco, alcohol, opium, chloral, bella- 
donna, has a tendency to either destroy or dwarf the sperma- 
tozoa, so that they are incapable of fertilizing the ovum of the 
female; whereas some disease-germs, as syphilis, destroy the 
vitality of spermatozoa completely. In prostatitis and sperm- 
atorrhoea the acid, or acid secretion from that gland invariably 
destroys the sperm-cell. 

(4.) Sterility in Women. — May arise from mal-position of 
uterus, simple displacement, or anti or retroflexion. All inflam- 
matory states, with thickening and ulceration ; intra-uterine 
catarrh, or congestion of mucous coat, such as we have in mem- 
branous dismenorrhcea ; elongation of the neck of the uterus, or 
engorgement, or induration, or cartilaginous degeneration of 
neck, such as we have in mechanical dysmenorrhea ; oblitera- 
tion, obstruction, or great narrowing of the mouth of the uterus or 
cervical canal ; closure of the uterine cavity by a tumor or can- 
cer ; atrophy of the uterus ; occlusion of Fallopian tubes $ partial 
or complete rupture of perinseum ; recto-vaginal or vesico-vaginal 
fistula; suppression of menses form fright, or any cause; gen- 
eral weakness, debility, self-abuse with finger, towel, or rubber 
apparatus; too frequent, promiscuous, or imperfect sexual ex- 
citement. There may be an absence of uterus, ovaries, or simply 
an arrest of development. Leucorrhoea, as a rule, whether an 
abundant or acrid one, is almost sure to destroy the spermatozoa 
before they reach the ovule. Disease-germs, in blood, tubercle, 
syphilis, as well as those drugs already enumerated — opium, 
alcohol, chloral, bromide of potass, belladonna, digitalis — destroy 
the fecundating faculty of the ovarian bed, and the vitality of 
ovules, if an}' are secreted. 

Besides those causes of sterility, there is a very prolific one 
in incompatibility of temperament, or related by blood ties ; 
in antagonistic and opposite races. Where the temperaments 
of father and mother in the Caucasian are perfectly identical 
there is no fertilization of the ovum, even if both ovuies and 
spermatozoa are healthy and abundant. The same result of non- 
procreation takes place where both parties are tubercular or 
syphilitic. A Cretinian never begat a Cretinian, nor an Albino 
an Albino. These latter are, however, to be explained on the prin- 
ciple that there is no establishing a morbid race. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 499 



DISEASES OF THE FEMALE ORGANS OF 
GENERATION. 



PRURITUS OF THE VULVA. 

Irritation of the vulva may be simply a local affection, or 
depend upon acrid discharges from above. Whicheverof the 
two conditions exists, it causes a degradation of the bioplasm 
concerned in nutrition of the vulva, giving rise to a disease- 
germ, or fungus, and thus rendering pruritus of the vulva 
both contagious and infectious. 

The same condition often takes place at the anus, giving 
rise to anal pruritus, pruritus pudendi. It is most common 
in advanced life ; in some ladies very troublesome during 
pregnancy. Mai -nutrition, in some cases, can be traced to the 
root of the difficulty; the urine, in melituria, is a common 
cause. 

Symptoms. — Itching, tingling, formication, or smarting, 
which becomes intolerable when patient becomes heated, or if 
stimulants and warmth are applied. The rubbing or scratch- 
ing causes excoriations and scabs about vaginal labia, perinaeum 
and mons veneris. The constant annoyance of this at night, 
gives rise to restlessness, loss of sleep, want of appetite, and con- 
stitutional disturbance. 

Care must be observed to distinguish this from crabs, or pru- 
rigo of the skin. 

Treatment. — Bathing the parts with tepid water and castile 
soap, morning and night, drying well and then rubbing in 
with ozone ointment is usually sufficient for a cure, unless it 
depends upon dyspepsia, or melituria, or some uterine diffi- 
culty, as chronic inflammation of the uterus, or excoriation of 
uterine labia. When it occurs in the later months of pregnancy 
nothing can be done but palliate the condition. If there is 
indigestion, tonics and antiseptics internally, as cinchona and 
mix, or mineral acids, ozonized glycerine. Any uterine trouble 
aside from pregnancy must be removed, and antiseptic vaginal 
injections used three times daily, as lotions of permanganate of 
potassa, borax, or zinc. If the ozone ointment is in any way 
unpleasant, then a lotion of borax, morphia and glycerine 



500 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

could be used and kept in place by a T bandage ; or lime-water 
and tincture of iodine ; an infusion of lobelia with borax ; tinc- 
ture of iodine in elder flower water. 

INFLAMMATION OF VULVA. 

Several forms of inflammation may attack the vulva. 

(1.) Simple Vulvitis. — This is not very common, but may 
take place from want of cleanliness ; violence, as in forcible 
sexual intercourse, or where this act is excessive ; the irritating 
discharge of a gonorrhoea ; or from irritation from adjacent 
structures, as rectum, uterus. 

Symptoms. — Usually sufficient constitutional disturbance 
to give rise to fever ; the vulva becomes painful, swollen, and 
very tender. Mucous discharge, with heat or scalding during 
micturition ; considerable aching in back, loins, and thighs. 

Treatment. — For fever, aconite and sweet spirits of nitre. 
Open bowels with salines or compound liquorice powder. 
During the day, hot fomentation of borax and chamomile 
flowers ; during night, linseed or slippery-elm poultices. Lat- 
terly, lotions of glycerine, borax and morphia. 

(2.) Gangrenous Vulvitis. — In cases where prostitution is 
loose and varied, where vital force is greatly shattered, where 
the mercurial or syphilitic cachexia is sapping the springs of 
life, and in still more rare cases, after delivery, there is often 
inflammation of the vulva, and with it the oidium albicans of 
diphtheria appears on the parts. The mycelia find this a 
most congenial location, for with most extraordinary rapidity 
an ulcerative process sets in and destroys the labia. 

Symptoms. — Nausea, vomiting, prostration, fever, anxiety, 
vulva swells, becomes red, then livid and gangrenous. Dis- 
ease progresses, large diphtheric patches form and are exfoliated 
or slough off, leaving rough, uneven, ragged edges ; eats rapidly 
to pubes or uterus. A true sloughing phagedena. It is highly 
contagious and infectious. 

Treatment. — Control fever with aconite, veratrum viride, 
etc. Administer internally either carbolic acid and tincture 
of iodine every hour ; or brewer's yeast, or ozone-water thrice 
daily. Quinine and aromatic sulphuric acid, or compound 
tincture cinchona and mineral acids internally. A perfect 
alleviation of pain with morphia. Locally, select either a lo- 
tion of permanganate, or borax, or morphia and glycerine, and 
alternate with yeast and charcoal poultices. 

As the cause of this difficulty, or rot, is worn-out vital force, 
construction is the rule ; so essence of beef, milk, cream, raw 
eggs ; everything to make good, pure blood. After the case is 
beginning to do well, push ozonized glycerine. 

(3.) Follicular Inflammation of the Vulva. — An irritation, 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 501 

inflammation of the sebaceous follicles, scattered over the mu- 
cous membrane of the vulvo-vaginal entrance, around the 
nymphse, and at base of clitoris. 

The cause or source of irritation is often obscure. Most 
common during pregnancy or change of life; usually in- 
tractable. 

Symptoms. — Always disturbance of the general health ; 
lassitude, debility, liver torpid ; bowels constipated ; skin dry 
and harsh ; pains in back and thighs ; always more or less leu- 
corrhcea, w T ith irritation, soreness, smarting ; sexual intercourse 
very painful. On an examination of the parts, they are usu- 
ally found to be more or less inflamed ; studded with numer- 
ous raised vascular joints, filled with sebaceous matter, with 
specks of ulceration on their summits. These points are so 
numerous that they coalesce, forming a strip of highly injected 
mucous membrane. This vascularity or redness soon disap- 
pears, and leaves the tissues covered with sebaceous secretion, 
looking as if covered with white paint. The leucorrhcea be- 
comes acrid, and there is constriction of the sphincter muscle 
of the vagina. 

Treatment. — The case should be treated with general bath- 
ing, gentle exercise ; stimulating liver with salines, or cascara 
sagrado ; diet should be plain, unstimulating, but nutritious. 
If there is no pregnancy the menstrual flow should be stimu- 
lated with compound betin pill ; then a course of general vege- 
table alteratives and tonics should be inculcated and adhered 
to; locally, the vagina should be thoroughly injected thrice daily 
with copious injections, ranging from a pint to a quart, of 
washes of tepid water and permanganate, or borax, or lime- 
water and glycerine ; the external parts smeared over with 
ozone ointment. Usually the case recovers rapidly with the 
above. If stuborn, after the evening vaginal injection, hip-bath, 
and introduce into vagina pastile of belladonna and iodide 
of lead. As far as possible, let all local remedies be alkaline 
antiseptics. 

(4.) Pudendal Erythema. — Women, as well as men, es- 
pecially if of a corpulent habit, are liable to chafe or become 
excoriated about the labia, inside of the thighs, perinseurn and 
adjacent parts. It may come on from want of cleanliness, or 
excessive exhalation of moisture with some sebaceous secretion. 
The parts take on a true erythema, with bacteria. There is red- 
ness, burning heat, tingling and great discomfort. Bathing 
parts morning and night, and drying by pressure, anointing 
with oil, or sprinkling with any antiseptic powder, as powdered 
white oxide of zinc or spermaceti, or borax, either one is suf- 
ficient to establish a cuie. 

Infantile Leucorrhcea. — Consists generally in an irritation, 



502 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

inflammation of the mucous glands of the vulva, causing a 
profuse muco-purulent discharge. 

Causes. — Common causes, teething, worms, mal-nutrition, 
bad, or insufficient food. 

Symptoms. — Tubercular children, suffering from very 
slignt derangement of the health, or bad feeding, and under- 
going the ordeal of difficult dentition, or having ascarides, are 
the victims of leucorrhoea. It may be only a moisture, or slight 
mucous discharge, with irritation of the surrounding parts ; 
but if, as is generally the case, the irritation extends up the 
vagina, the discharge is usually profuse, muco-purulent and 
loaded with bacteria, which renders it contagious and infec- 
tious. Besides, there is usually pain during micturition, heat, 
scalding and excoriation, and if not attended to, ulceration. 
Great caution, if mother is ignorant, in not attri outing it to 
gonorrhoea or attempted rape. 

Treatment. — Place little patient upon the very best of diet, 
the most nourishing its circumstance and age will warrant. 
Inculcate bathing morning and night. Keep part clean with 
antiseptic lotions, borax and glycerine, or chlorate of potass. 
Look carefully for seat worms, and use daily injections into the 
bowels of some bitter infusion, and administer tonics and alter- 
atives. 

During the progress of the eruptive fevers, or diphtheria, 
there is often difficulty about the vulva, scarlatinal vaginitis, 
or exfoliation of diphtheric patches — best attended to with anti- 
septic fomentations and general treatment. 

TUMORS OF THE VULVA. 

Besides being subject to different forms of irritation and 
inflammation, the folding doors of the vaginal entrance are lia- 
ble to several forms of growths, tumors, infiltrations, abscess, etc. 

(1.) Encysted Tumors. — A firm, elastic tumor, varying in 
size from a pea to a walnut, having its origin either in connec- 
tive tissue of vaginal labia, or in one of the lobules of the 
vulvo- vaginal gland, or in entire gland. 

Symptoms. — When small it does not give rise to much 
trouble, but when larger it creates discomfort in walking, or in 
moving legs ; pain after intercourse ; irritability of the bladder ; 
disturbance of catamenial periods. If irritation of walking 
is kept up, inflammation of the cyst may take place, followed 
by suppuration and abscess. 

Treatment. — The best method of treatment is to freeze the 
part over the cyst pretty well, and make incision over it and 
turn the cyst out with handle of scalpel ; if a simple incision 
is made into the cyst and its contents evacuated, it is necessary 
to touch the internal lining membrane of sac with tincture of 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 503 

iodine so as to destroy its secreting faculty. A seton answers 
well without incision, but somewhat painful. 

(2.) Fibrous Tumors. — Fibroid and fatty tumors are occas- 
ionally developed in the labia majora, and perinseum ; they 
are met with variable in size from a small nut to an orange. 

Treatment. — Apply ether spray to deaden sensibility and 
remove by simple incision. They can be absorbed by ozonized 
clay, but it is here difficult of application. 

(3.) Warty Growths. — They are met with scattered round 
•the labia, nymphse, vestibule, perineum and around anus. 
Sometimes they are covered with a cuticle ; in other cases they 
look like strawberry excrescences and appear in clusters. They 
give rise to irritation and offensive secretion, which affects other 
parts. They are very troublesome, if urine is acid, on or near 
the orifice of the urethra. Removed by chromic acid, if parts 
permit of its application ; if they do not, the super-sulphate of 
zinc. 

(4.) Abscesss of Labia. — May occur from violence, blows; 
kicks, forcible sexual intercourse, irritation of gonorrhceal mat- 
ter, or acrid leucorrhceal discharges, pressure of head in labor. 

There is always constitutional disturbance, rigors, fever, 
pain, heat, swelling, throbbing. After using hot linseed poul- 
tices, a free incision. Tonics and good diet. 

(5.) Hypertrophy of Labia. — This, to a limited extent, is 
common. Most inconvenient. The enlargement may exist 
in an unusual thickness of skin, in deposit of fat in cellular 
tissue, or general increase in size. In some cases, when the 
increase in bulk is due to elephantiasis, it attains an enormous 
size. 

Treatment. — Alteratives are about the only remedies of 
utility. 

(6.) Pudendal Hematocele. — Extravasation of blood into 
the areolar tissue of the vulva, or labia, takes place as the result 
of violence or labor, and usually consists of a sanguineous tumor, 
or large clot, from the rupture of some vessel. 

Symptoms. — Considerable swelling, following some injury, 
forming at first an elastic swelling. In women of very fine 
structure, it may burst ; more frequently it coagulates and is 
absorbed. 

Shave parts, and apply a lotion of muriate of ammonia, and 
tincture of iodine; alteratives and iodide of potass internally. 
These remedies failing, after a fair trial, rub gently over the 
part an ointment of iodide of cadmium. 

An absence of hair on mons veneris, and other parts, is 
met with, but due to syphilis, or tinea, where the parts are 
smooth ; in other cases, there is a remarkable redundancy, in 
quantity as well as length. 



504 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

CORRODING ULCER OF THE VULVA. 

Rodent, or corroding, or eating ulcer of the external geni- 
tals, is only to be met with where the vital forces are very much 
shattered, or where great depravity, over-crowding, or filth 
exists. 

Sypmtoms. — It usually exhibits itself in the form of an 
intractable ulceration of the labia, and extends over vulva and 
vagina; surrounding structure usually becoming indurated. 
As ulcer heals in one direction, it extends to another ; process 
of repair accompanied by the formation of a firm, horn-like 
cicatrix, which has a tendency to cause a puckering, or con- 
traction of the vaginal walls, or anal orifice. As a rule, patient 
does not experience much inconvenience from it for a long 
time ; not until the vaginal orifice, or neck of the bladder, be- 
comes fissured by it; then the patient experiences great pain 
after micturition. For a long time it seems not to interfere 
much with sexual congress, or menstruation. By-and-by gen- 
eral health becomes greatly impaired, appetite fails, the body 
wastes, there is diarrhoea, night-sweats, a profuse discharge 
from the parts, very offensive, and a general breaking-down of 
the health. 

Treatment. — Rest must be enjoined, the secretions regu- 
lated, the function of skin stimulated with baths ; appetite 
promoted with tonics, and the very best of nourishing food 
given ; every means possible taken to build up general health. 
An alterative and tonic course of treatment persevered with for 
some months. Locally, no caustics. The vagina should be 
thoroughly washed out twice or thrice daily, by injecting at 
least a quart of tepid water, medicated with borax, permanga- 
nate of potass, or some antiseptic. Over affected part a good, 
thick coat of ozone ointment, three times a day, or vaseline 
and quinine. 

In some cases, lotions of antiseptics ; if used, they must be 
kept moist. They should be of a softening, emollient kind, as 
glycerine, borax, and morphia, or infusions of wild indigo and 
chlorate of potassa; lime-water, and tincture of iodine; which- 
ever is used should be re applied fresh at intervals of three 
times a day. 

CANCER OF THE VULVA. 

The cancer-germ may be deposited on the labia, or vaginal 
walls ; it may be found in acute (medullary), scirrhus (chronic), 
or epithelial form. When confined to the external labia, the 
disease is easily got rid of by the treatment laid down under 
that of Cancer. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 505 

VASCULAR TUMORS AT ORIFICE OF URETHRA. 

In the female, aside from warts, there is often met with vas- 
cular tumors at or near the orifice of the urethra. 

These excresences vary in size from a pea to a walnut. Usu- 
ally they are highly sensitive, exquisitely painful, giving rise 
to most excruciating pain and irritability in making water, 
which continues for some time. They also give rise to irritable 
bladder, pain in back, and considerable constitutional disturb- 
ance. The only treatment is either excision, or ligation, or 
destruction with caustics, as chromic acid, supersulphate of 
zinc, salicylate. 

Keep urine alkaline during the process of healing, and in- 
culcate a general tonic and alterative course of remedies. 

DISEASES OF THE CLITORIS. 

In ballet, or dancing-girls, the clitoris is often attacked with 
inflammation, effusion of lymph, and enlargement. In some 
cases, the hypertrophy is great, and terminates in abscess ; in 
other cases, in cystic degeneration. The excessive development 
is in some cases congenital, being so large that some are in doubt 
but that they may be males. The clitoris is sometimes the seat 
of cancerous deposit. The entire organ may be diseased, or its 
prepuce. 

Induration or enlargement may be due to self-abuse. 

The treatment of inflammation, and its results, must be upon 
general principles, with alteratives and tonics. 

Nymphomania. — Constant and distressing desire for sexual 
intercourse, with an erectile condition of the clitoris ; may arise 
from disease of the brain, spinal cord, inflammation of clitoris, 
from masturbation, or excessive venery, sedentary habits or 
occupations, and, above all, by the vascular excitement that is 
produced by our abominable, sensually exciting literature. 

Treatment. — Removal of cause, plenty of exercise, or hard 
work ; daily shower bath, well-regulated bowels, sleep on straw 
or hair mattress, light covering ; cold water hip-baths, and vagi- 
nal injections of cold water, except during menstruation ; large 
doses of green root tincture of gelsemium and bromide of potass 
at bedtime, or comphor, belladonna, and conium, to cut off sex- 
ual desire ; alteratives and tonics administered persistently ; a 
strict avoidance of all light literature ; a pure, moral atmos- 
phere; same treatment as for masturbation in male. The 
amputation, or partial destruction of the organ with caustic 
potassa, is of doubtful benefit. 

In cases of inflammation, rest, open bowels freely, hot poul- 
tices, and general treatment for fever. 



506 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

DISEASES OF THE VAGINA. 

The vagina, or sheath, or scabbard, or canal leading to the 
uterus, is subject to a variety of morbid conditions : 

(1.) Occlusion. — There may be a tough or hypertrophied 
hymen, either partially or completely closing the vaginal canal, 
through which, if partial, menstrual discharge may escape ; 
but which, if complete, it prevents its exit entirely. If it 
cannot be ruptured by the finger, either a longitudinal or cru- 
cial incision should be made through the obstructing mem- 
brane, and reunion, if unmarried, prevented by inserting oiled 
lint in the cut part ; if married, sexual congress is to be per- 
mitted, which will keep the parts all right. If the band, or 
hymen, closes the canal completely, so that no sexual congress 
can be permitted, nor menstrual discharge escape, just satisfy 
yourself that there is a canal and a uterus, and, if so, an incision 
must be carefully made into it. In some cases of imperforate 
vagina, the congenital malformation is so complete that the 
vagina may be either adherent or altogether absent, or a stric- 
ture may intervene. In all cases the greatest care and caution 
are necessary in an}^ surgical proceeding. If vagina is entirely 
absent, little can be done. 

(2.) Vaginismus, or Painful, or Difficult Sexual Connection. — 
An irritable, spasmodic condition of the sphincter muscle of the 
vagina, with such excessive sensitiveness of the parts and of the 
surrounding tissues as to form a complete barrier to coition. 

It may exist in various forms or degrees. In some cases, it 
is a mere tenderness, or increased sensibility ; in other cases, 
the sensitiveness is great, amounting to a distress, or severe 
agony, the slightest touch giving intense pain. This super- 
sensitiveness is due to a pure neurosis from altered nutrition, 
and we can find nothing tangible to account for it; or the 
cause may be clear, as some irritation, which causes inflamma- 
tion of the mucous follicles above the vulva, and spasm of the 
muscular fibres ; a true closure, or tonic spasm of an involuntary 
muscle. What the irritation may be that gives rise to this is 
somewhat varied. There are various examples of spasm, or 
contraction, to be found in the uterine appendages ; for exam- 
ple, irritation of the clitoris causes contraction of the uterine 
horns; irritation of the urethral orifice causes contraction of 
the fundus of the bladder. In the largest number of cases of 
painful or difficult connection, the trouble is not discovered 
until sexual intercourse is attempted, and then the mere touch- 
ing of the parts throws the woman into a paroxysm of intense 
agony. 

In the more simple forms, nothing can be detected in the 
lady to lead us to suspect its existence. It may even come and 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 507 

go, and its coining and going has nothing whatever to do with 
the sexual appetite, because it is not necessary for conception 
that a woman should have sexual desire. Women affected 
with painful connection may conceive and have a child, and 
the birth of the infant may not cure the desease ; but it gener- 
ally happens that the great distension and laceration of the 
vagina causes it to become less. 

In a large proportion of cases the true condition is found, in 
newly married women, in a redness, or fissure, at the anterior 
margin of the perinaaum, or in the fossa navicularis around the 
hymen. In some cases a true ulcer or an imperfectly ruptured 
hymen with ulcer which may heal and break out again and 
again and form little hypertrophies at seat of hymen, which 
are intensely tender and irritable. These ulcers are of a lupoid 
or eczematous character generally. It is only when pain and 
sensitiveness exists, and are extreme without textural difference 
that the condition may be said to exist. 

The treatment consists in the removal of cause, the use of 
alterative injections, belladonna, and lobelia pastiles, with alter- 
atives and tonics. 

Few cases resist a persistent course of alteratives and tonics, 
withgood diet. The best pessaries to introduce at bed-time are 
belladonna and opium, borax and camphor. 

(3.) Acute Inflammation of Vagina. — May be due to the 
venereal poison, or may arise from violence, as the pressure of 
a foetal head in tedious or lingering labor; from the use of whale- 
bone, knitting-needles, etc., with which some ladies make inef- 
fectual efforts to commit abortion, and often irritate and perforate 
the vaginal walls ; it may also be due to a want of cleanliness, 
especially if powers of life are feeble, or system vitiated. 

Symptoms. — As the condition of partial death is seldom lim- 
ited to the mucous coat, the symptoms are often severe constitu- 
tional disturbance, rigors, and a fever. In the vagina the soreness, 
rawness, and heat is intense ; itching about the vulva, irrita- 
bility of the bladder and rectum. At first the mucous mem- 
brane is dry and swollen, the secretion of mucus checked ; then 
a watery effusion, and, by-and-by, a thick, creamy mucus or 
heavy muco-purulent matter, or pure pus, is poured out ; then 
pain, soreness, and rawness are relieved. There is pain in the 
back, hips, and upper part of the thighs ; a sense of weight and 
bearing-down, with considerable smarting and soreness. Inflam- 
mation runs its course in a week or ten days, and may termin- 
ate in recovery or in a chronic form. If the deeper seated parts 
of the vaginal walls, as the sub-mucous and muscular coats, are 
involved, the above symptoms may be more violent, the fever 
greater, pulse wiry, rigors often, and pain in vaginal walls 
throbbing ; abscess may form and grave changes take place. 



508 DISEASES OP THE FEMALE ORGANS OF GENERATION. 

Treatment. — Patient must be confined to bed, and the gen- 
eral treatment for fever resorted to — aconite, veratrum, and 
sweet spirits of nitre ; body sponged thrice daily, and bowels 
opened with cascara sagrado ; injections of warm sweet milk and 
water, or linseed tea, or slippery-elm-water every three hours. 
To either of these injections opium to be added ; suppositories 
of belladonna and opium. As soon as fever abates, and local 
symptoms become easier, change injections to tepid water and 
borax, or permanganate potass, and internally, give iodide of 
potass in some vegetable alterative, in alternation with tonics 
as compound cinchona and mineral acids, quinine and aro- 
matic sulphuric acid, with very nutritious diet of fish, eggs, 
milk, ripe fruit, and drinks of infusion of marshmallow or lin- 
seed ; fomentations of chamomile flowers, or linseed poultices to 
vulva. If abscess appears, open early. 

(4.) Chronic Inflammation of the Vagina. — Leucorrhcea, 
or the whites, one of the most common diseases to which women 
are liable, consists in a low grade of irritation of the vaginal 
walls, and a muco or muco-purulent discharge. 

Causes. — Are numerous and varied ; greatly predisposed to 
by self-abuse, married life, tropical climate, by emmenagogue 
drugs, sedentary habits, trashy literature, and certain occupa- 
tions requiring the continued movement of limbs — the more 
active exciting causes being frequent coition, many abortions or 
pregnancies, want of cleanliness, debility, etc. Indeed, any- 
thing that tends to weaken or impair the vitality of the vaginal 
coverings, the droppings or exudations in all morbid conditions 
of the uterus invariably irritates vagina and gives rise to leu- 
corrhcea. 

Symptoms. — The constant or frequent leucorrhceal dis- 
charge, " the whites," is to be regarded as the essential symp- 
tom. This discharge may be mucus, or muco-purulent matter, 
or pus, or an exfoliation of the epithelial covering of the mu- 
cous membrane. There is general debility, languor, lassitude, 
probably headache, with backache more or less severe, and an 
indescribable weariness on the slightest exertion ; loss of appe- 
tite, indigestion, flatulence, and constipation ; tongue coats, 
breath fetid, and usually some mental depression. 

Treatment. — The cause or causes must be removed, and 
then there is little difficulty in aiding nature to a cure. If 
there is any uterine trouble it must be got rid of before we can 
expect a permanent result. The local treatment, in all cases, to 
be discontinued during catamenial period. Cold water hip- 
baths, morning and night ; vaginal injections three times a 
day, if possible ; if not convenient, twice a day. Those vaginal 
ablutions should be very thorough, patient should sit down on 
a chamber, with a vessel containing a quart, at least, of the 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 509 

injection, before her; the tube of syringe, well oiled, should be 
inserted up vagina until it feels unpleasant ; the other end of 
the syringe in the medicated fluid, the bulb in her hand, which 
she is to compress and relax until the entire quantity is thrown 
up. As the injected fluid thus thrown up, is spread in innu- 
merable directions, if done with some force, it runs round neck 
of uterus, cul-de-sac, and flows down vagina into the chamber. 
If the cost of the injection is great, then a quart of water thor- 
oughly impregnated with Castile soap should first be thrown 
up, then a hall or an entire teacupful of the medicated fluid. 
But cheap washes of real intrinsic value should be selected, as 
borax, permanganate of potassa, lime-water, and tincture of 
iodine, or infusions of golden seal, gold thread, bayberry, oak 
bark. 

Alum, iron, zinc, tannic acid, are not to be recommended, as 
they possess no real merit ; they may astringe, but cannot cure. 
The constitutional treatment is of the greatest importance: 
daily bathing ; bowels opened with the most gentle remedies, 
as cascara, and the patient placed upon alteratives and tonics. 
Of the former, ozonized phytolacca compound, stillingia and 
iodide of potass two hours after meals ; of the latter Port wine 
and Peruvian bark, compound tincture cinchona and mineral 
acids, or sulphate of quinine, and aromatic sulphuric acid, half 
an hour before meals. Diet to be generous and nutritious. 

In this simple manner the most aggravated cases of leucor- 
rhoea may be cured, and well cured — the tonicity of the vagina 
restored, and the patient made to feel that life is a comfort. 
All the symptoms quickly disappear, and she regains her usual 
vivacity and vigor. 

There are cases, in which the symptoms are more aggravated 
than the above — cases in which there is redness and great 
muco -purulent discharges; or others in which the mucous 
membrane is of a doughy hue, with mental depression and a 
thick ropy flow; whereas in prostitutes, or where excessive 
coition is the cause, the color of the mucous membrane is pur- 
ple or livid, and shrunken, with copious oozing. In all such, 
and even in some mild cases, the discharge is pretty well 
loaded with bacteria, amoeba, and other disease-germs, and is 
somewhat contagious. 

In those cases, in order to make short work with diseased 
action, wash out vagina thoroughly, and then use the following: 
Take of the ozone et chlorine fluid, three ounces, and add it to 
one pint of tepid water, and inject slowly. This creates a per- 
fect revolution in the tissues, substituting healthy action for the 
diseased. After a few days rest the milder injections of infusion 
of golden seal and borax to be used. 

(5.) Prolapsus of the Vagina. — Cases of partial and com- 



510 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

plete prolapsus of the vagina are common in large, flabby 
women who have been addicted to self-abuse, or tight-lacing, 
or borne many children, or had numerous miscarriages, and 
who have large, capacious vaginas. It may be also due to 
lifts, strains, coughing, self-abuse. The partial form is more 
common than the complete. When the front part alone is 
affected, it draws down the back portion of the bladder, and is 
called vaginal cystocele ; if the back wall of the vagina falls 
down, it draws down the front wall of the rectum, and is 
termed vaginal rectocele. In the former case, urine is apt to accu- 
mulate in a pouch formed by the bladder ; the latter a pocket 
forms, in which hard fecal masses are retained, causing a sense 
of weight and irritation. 

Symptoms. — Prolapsus, or protrusion of the vagina, either 
alone or accompanied by prolapsus of the uterus, if it is com- 
plete, that is, involves the entire vagina, it forms a projecting 
tumor at the vulva, its surface inflamed or excoriated ; bladder 
is very irritable and there is great difficulty in emptying it. 
It gives rise to much suffering, pain in the back, thighs, and 
bearing-down; and reflex s} r mptoms, as headaches, spasms, or 
hysterical attacks. 

Treatment. — The bladder and rectum must be emptied 
daily ; the patient placed upon tonics, as cinchona and min- 
eral acids, or sulphate of quinine, and aromatic sulphuric acid, 
or nux vomica and fluid extract hydrastis ; the most nourish- 
ing food, and as much rest in the recumbent posture as pos- 
sible. There should be an avoidance of straining, lifting, 
coughing, and above all things, tight-lacing. Injections of 
solutions, or infusions of alum, sulphate of zinc, oak bark, hem- 
lock juice, etc., one or the other should be resorted to thrice 
daily, and pastiles of tannin and kino introduced at bed-time, 
it being clearly understood that before any of these are used, 
that the protruded walls be returned. There is no good in a 
T bandage and a pad or compress, because the pressure on the 
waist overcomes all benefit; neither is there any use in pessaries, 
as they make matters worse. A piece of silk sponge cut in the 
shape of a pear, base upwards, medicated with tannin, may be 
of some utility. Cold water hip-baths are not to be neglected. 
If these simple means fail, after a fair trial, then a radical cure 
can readily be effected as follows : In diminishing the calibre 
of the canal, in exciting seven pillars of plastic inflammation, 
or effused lymph to prop it up. It is performed as follows : 
Bladder to be evacuated, rectum thoroughly syringed ; the va- 
gina to be washed out with a quart of soapsuds ; the protrusion 
returned; then introduce a proper-sized speculum, with a win- 
dow ; wipe dry the part of the vaginal walls opposite window ; 
then take chemically pure nitric acid and paint a vertical 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 511 

streak one-quarter of an inch wide and two and a half inches 
long ; paint it neatly and carefully seven or eight times ; when 
finished, turn speculum half an inch and repeat the same pro- 
cess by making another, and another, until seven good streaks 
are made. Before removing speculum, fill it with a piece of 
lint, saturated with olive oil, which, hold firmly with a ramrod ; 
then withdraw the speculum, leaving the oiled lint in vagina. 
Administer one grain of opium, every three hours, to lock up 
the bowels ; keep patient in bed ten days, with a catheter in 
bladder; permit no straining, laughing, or lifting for some time ; 
bowels to be opened with enemata, or cascara sagrada. This is 
the most effectual method, if well performed. The oiled lint 
need not be disturbed for a week, unless there is some uterine 
difficulty above; if there is, it may be necessary to remote it 
inside of twenty-four hours. On the removal of lint, injections 
of cold linseed tea or slippery-elm-water ; all through, pushing 
tonics and good diet. 

(6.) Vaginal Tumors. — Common growths on vaginal walls 
are : 

Mucous Cysts. — The orifice of the mucous follicles may become 
closed from some cause, and the follicle may be dilated into a 
cyst ; they may be superficial or deep-seated ; if they can be easily 
reached, punture, and use ozone et chlorine wash. 

Fibrous Tumors.-^A nodule of fibrous tissue is often found 
imbedded in the vaginal walls in sub-mucous tissue. They are 
liable to give rise to haemorrhage. They are best removed by 
dividing the mucous membrane over it, and shelling it out 
with handle of scalpel. 

Polypus of Vagina. — May be either of three kinds, (see Polypus 
of Nose), and may give rise to bearing-down, leucorrhcea, irrita- 
ble bladder, haemorrhage. They may be snapped off or ligated, 
and, after their removal, one application of ozone et chlorine, 
and then washes, as for leucorrhcea. 

DISEASES OF MENSTRUATION. 

In the Caucasian female menstruation takes place between 
fifteen and forty-five years of age ; in some cases a little sooner, 
in others later. The sanguineous exudation, in health, takes 
place every twenty-eight days, and in quantity varies from one 
to four ounces, and is unaccompanied by pain. Two-thirds of 
all ladies menstruate about the end of the month, the other 
one-third about the fourteenth. In a condition of health, this 
periodic evolution should be regular ; no arrest, nor excess, nor 
difficulty, only during pregnancy and nursing, when it should 
cease. If it does not suspend during pregnancy, and for fifteen 
months after the birth of the child, the proper duration of lacta- 
tion, measures must be taken to cause its disappearance, as it is 



512 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

highly detrimental to the health of the child. These measures 
should consist of an avoidance of coition, or reading of our 
modern literature, in the daily use of hip-baths, and remedies 
to strengthen the system. There are three different morbid 
conditions of menstruation, — amenorrhcea, dysmenorrhcea, and 
haemorrhagia. 

Amenorrhcea. — An absence of the menstrual flow. It is met 
with under two forms : 

(1.) Retention of Menses, — This may depend on a variety of 
congenital conditions, as arrested development, organic affec- 
tions, malformations, such as absence or atrophy of ovaries, 
uterus. Those organs may be present, but vagina may be ab- 
sent, or suffer occlusion, so that if the menses are secreted, that 
they cannot find their way out. It may depend on some disease 
of brain, spinal cord, or blood. A large percentage of such cases 
can be rectified either with medical treatment or some surgical 
proceeding. 

(2.) Suppression of Menses. — This is the most common form of 
amenorrhoea. The flow having appeared, been properly estab- 
lished, for a longer or shorter time, has, from some cause, become 
suddenly arrested. 

The front part of the uterus being very profusely supplied 
with branches of the s t ympathetic nerve in highly-civilized 
females, the menses, while on, are liable to cease or stop from 
violent emotion, grief, anxiety, or from cold, damp, exposure. 

Instead of ceasing suddenly, as in those cases, it may disap- 
pear gradually, returning at the proper time, but becoming 
less and less, and then entirely stopping. It is liable to cease 
in acute and chronic disease, as in fevers, blood-disease, espe- 
cially anaemia, cancer, tuberculosis, albuminuria. In all cases 
the greatest care should be observed, so as not to overlook 
pregnancy. The suppression is always attended with some con- 
stitutional disturbance; great, if sudden; not so well marked, 
if slow and gradual. 

Treatment. — If the case is seen at once during an attack of 
acute suppression, there should be an effort made to re-estab- 
lish the flow, by alcoholic vapor-bath, with hot mustard foot- 
bath ; put to bed between blankets, with hot bricks to feet, and 
dry heat to vulva or over bladder, consisting of baked bran, 
or hops, or chamomile flowers, in bags. Aconite, with com- 
pound tincture of serpentaria, administered internally, with 
infusion of pennyroyal ; no cold drinks nor ice. If several days 
have elapsed, it is useless to try the above, or any other means, 
but begin at once and prepare patient for next period. Bowels 
should be regulated, clothing warm, flannel round waist and 
hips, warm foot and hip-baths, nourishing food. If there is 
any special disease it should be attended to, especially anaemia, 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 513 

with acetate of iron three times daily, with cinchona and min- 
eral acids ; and about a week before the expected period, begin 
with the compound betin pill, one or two three times a day; 
and if the case is stubborn, put mustard plasters on the nip- 
ples, for a short time before bedtime, for one or two nights. 
The compound betin pills excel all drugs in their mildness, 
efficacy, and certainty ; the}' arouse the inert, sluggish uterus 
into active life, restore its natural movements, and impart tone 
and vigor ; they are our best emmenagogues, and excel all other 
drugs in their prompt action. They supersede entirely those 
old and deleterious drugs, such as cotton- root, savin, aloes, 
ergot. As soon as the flow is established they are to be stopped, 
and resumed the following month about seven days before the 
expected period. Ladies who suffer from habitual suppression, 
or where the flow is scanty, or who dread early suppression, 
can maintain menstrual activity for a long length of years, 
and thus keep the freshness of youth in their nervous system 
and skin indefinitely. 

Vicarious Menstruation may occur as a form of amenorrhcea ; 
that is, the menses may be suppressed at the vaginal orifice, 
but are thrown off by the nose, mouth, eyes, ears, or blood- 
stains by the skin, by ulcers or by necrosis, if present, or by 
odors about umbilicus, or eruptions. 

The real cause of vicarious menstruation is either inertia or 
atrophy of the uterus; so great that the uterine wave is abolished 
or abrogated. The cure consists in stimulating the uterus with 
hip-baths, horseback exercise, or moderate walking exercise, 
the betin pill, narcotics, iron, pulsatilla, cinchona, and most 
nourishing food. 

DYSMENORRHEA. 

Difficult or Painful Menstruation. There are three varieties 
met with in practice : 

(1.) Neuralgic Dysmenorrhea. — Nervous dysmenorhcea is 
very common among highly educated and refined ladies — 
those who have developed their nervous systems at the expense 
of the physical, those who have insufficient exercise for body, 
who lounge and keep reading our fictitious, debasing, modern 
literature — that deadly poison which undermines their ner- 
vous systems. It may appear at puberty, but more generally it 
comes on from enervating causes after some years of painless 
menstruation, especially in the unmarried. In married life, 
it may come on from the irritation of frequent abortions, and 
the use of means to accomplish that act. It may be due to in- 
compatibility in the sexual act. 

Symptoms. — General languor, lassitude, debility, headache, 
with pains in the back, sacrum and lower part of abdomen, 

45 



514 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

coming on a few days prior to period ; an aching soreness of 
inner and upper part of the thighs; bearing-down, with a sense 
of weight in the pelvis. As soon as the discharge comes on 
freely, relief is promptly experienced ; if the flow is scanty, and 
comes on in slight gushes, the suffering is often excruciating ; 
it becomes paroxysmal, pain comes and goes ; often consider- 
able pain in left ovary, sometimes in both ; no swelling or 
heat, or increased sensibility in parts. There is flatulence, 
constipation, hysterical symptoms or convulsions. 

Treatment. — During the attack, a warm hip-bath, teaspoon- 
ful doses of solution of morphia, every half hour, till relieved, 
with warm infusions of boneset. Then discontinue. A better 
plan is to let her inhale thirty or forty drops of chloroform, 
and give hyperdermic injections of one-quarter of a grain of 
sulphate of morphia ; that affords instantaneous relief. If 
aware of attacks coming on, they may be prevented by apply- 
ing a belladonna plaster across loins, four by nine inches long- 
ways across the back ; the administration of tincture of bella- 
donna internally, till throat becomes slightly dry and pupil 
dilated ; the introduction of a pastile up vagina, and supposi- 
tory up rectum, every night at bed-time, each containing one 
grain of opium and one-quarter grain extract of belladonna. 
The above to be commenced five days before period. 

From two to three weeks during the interval, the following 
treatment should be carried out vigorously : The bowels to be 
regulated with cascara ; daily, tepid alkaline bathing, followed 
by shower-bath or friction ; flannel next skin, especially over 
loins ; most nourishing food, easily digested ; avoid tea, coffee ; 
sleep on mattress, not over seven or eight hours ; abundance of 
exercise, games, moderate work, so locomotion is active ; horse- 
back exercise ; sedentary habits and novel-reading to be for- 
bidden ; if married, sexual intercourse to be avoided. Then place 
patient upon two of the following remedies each alternate week : 
Glycerite of ozone, ozone- water; hypophosphites in meat ex- 
tract, glycerite of keptaline ; cinchona in port wine, or mineral 
acids and cinchona. If there is any dyspepsia, stomach tonics 
in addition. 

(2) Congestive Dysmenorrhoea. — Membranous or in- 
flammatory dysmenorrhea may occur at any period of life, 
and in the large percentage of cases it is associated »with ple- 
thora and sanguine temperament. Its true origin is not well 
understood ; indeed, it is in uncertainty and doubt, but one 
thing is very certain, that there is congestion — a sort of inflam- 
matory condition of the internal lining membrane of the uterus. 
Whether this hyperemia is in the uterus, or in the ovaries, or 
in the pelvis, generally it is immaterial. 

Causes. — Aside from the diathesis, gouty or rheumatic, and 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 515 

pelvic irritation, general plethora of the genito-urinary organs, 
from sedentary habits and occupations, it may be caused by 
local irritation, as abortion, exposure to cold and moisture; 
sluggishness of the liver, displacement of uterus, and metritis. 

Symptoms. — Suffering begins four or five days before each 
period, in a general sense of languor, or weariness, with head- 
ache, pains in the loins; a feeling of weight in the pelvis; gen- 
eral restlessness, and irritability of the bladder ; there are heats 
and colds, with other evidences of nervous depression. The 
weight in the uterus becomes a pain of a throbbing character ; 
then dragging in the back, aching in the hips and thighs, and 
bearing-down, especially when pain is on. Discharge, after a 
few days suffering, makes its appearance, usually slowly and 
gradually, scanty at first, but subsequently, after the system is 
relaxed by the condition of prostration, it comes freely. It may 
come in small clots, or shreds, or flakes of membranes, or 
sometimes in the form of a large pear-shaaped clot, covered 
with a false membrane, an exact cast of the cavity of the 
uterus. This membrane looks like the epithelial membrane 
lining the cavity of the uterus, analogous to the decidua. In 
some cases there is no congestion of the uterus, in others it is 
much engorged, often displaced ; ovaries very tender, with swell- 
ing and tenderness of breasts. If the portal circulation is 
sluggish there will be piles. 

Treatment. — During the period, warm hip-bath, free action 
of bowels, opium to relieve pain ; belladonna and opium pas- 
tiles and suppositories ; hot, relaxing teas, like infusion of bone- 
set, same as in the neuralgic form. 

During the rest of the month, or when the period is over, pa- 
tient should have the best of food, bowels to be open twice daily, 
bathing daily, flannel, clothing, general alteratives and tonics, 
embracing such as ozonized syrup of phytolacca, with iodide of 
potass, ozone-water, glycerite of ozone, iodide of lime, or lime- 
water, and tincture of iodine ; with such bitter tonics as gen- 
tian, collinsonia, kurchicine. With those remedies, in the course 
of three or four months, a cure is effected. The plan is to select 
two, a tonic and an alterative, administer for a few days, then 
change on to other two, and so invariably keeping patient on 
either iodide of potass, or iodide of lime. 

To inject the uterus once a month with four ounces of dis- 
tilled water (milk warm), with twenty grains of iodide of potass 
dissolved in it, has a most salutary effect ; but American ladies, 
being so highly civilized, do not bear it well, it producing reflex 
symptoms that are often alarming, such as nausea, vomiting, 
numbness in hands and feet, and prostration. To guard against 
such, the four ounces should be placed in a hard rubber syringe, 
just holding that amount, with a male catheter point, carefully 



516 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

introduced into the uterus, and thrown in very gently, allowed 
to remain a few minutes, then every drop drawn back into the 
syringe, and then withdraw it. If performed carefully, and 
with nicety, there need be no trouble; it hastens a cure amaz- 
ingly, by producing a healthy action in the walls of the uterus. 
If there are no very distressing effects, it might be permitted to 
remain a short time, but in all cases never leave a drop in uterus. 
The best period to do it is about the middle of the month, be- 
tween the two periods. It is rarely necessary to repeat over 
three times in all. Moderate exercise; recumbent posture better 
for rest than sitting ; malt or alcoholic liquors, and sexual inter- 
course, to be avoided. Conception never takes place in a well- 
marked case. 

The shreds, clots, or coagula, are always loaded with the 
micro-organism bacteria. 

(3.) Mechanical Dysmenorrhea. — This term is applied 
to a thickening, induration, cartilaginous degeneration, or stric- 
ture of the external and internal os uteri, or neck, or a narrowing 
of the entire canal of the neck. It may also be due to some 
tumor, or uterine displacement, as anti or retro-flexion ; these 
latter we do not include in the following remarks. What we 
speak of here is either a narrowing of the canal of the neck, or 
its infiltration with lymph, or cartilage, or a true stricture of 
the external or internal mouths of the cervical canal — conditions 
that cause sterility as well as dysmenorrhoea. 

Causes. — The causes that give rise to this induration, or 
mechanical obstruction, are inflammation, such as acute and 
chronic vaginitis, leucorrhcea, self-abuse, excessive coition ; con- 
genital irritation common cause. 

Symptoms. — Are those indicative of obstruction to the escape 
of the menstrual fluid. There is the languor, prostration, nausea, 
vomiting, pain in loins, hips, and thighs, bearing-down ; pain 
in ovaries and uterus, usually some time before a scanty flow 
makes its appearance. When discharge does come, it is in 
gushes, each gush preceded by pain, and an aggravation of all 
the symptoms. The bladder becomes irritable, and there is 
often considerable tenderness over both uterus and ovaries ; 
anaemia, constipation ; very much resembles labor; uterus strug- 
gling to expel its contents. An examination of these cases 
reveals either a small os uteri, or an orifice of the natural size, 
but the canal leading to the internal os, thickened, indurated, 
strictured, or suffering cartilaginous degeneration — conditions 
that can readily be felt with the finger, or the uterine sound. 
In some cases the obliteration is confined to the inner os. In 
nervous or neuralgic dysmenorrhoea, the repeated irritation 
from month to month often aids in bringing about this con- 
dition. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 517 

Treatment. — Usual treatment during an attack, as already 
laid down, with the exception that tincture of green root of 
gelsemium, or lobelia, might be added to more effectually relax. 
There are several methods of treatment that can be tried during 
the intermenstrual period. In all it would be well to put 
patient under an alterative and tonic course of remedies, as 
ozonized saxifraga, phytolacca, glycerite of ozone, iodide potass, 
cinchona and mineral acids, attending to all minor symptoms, 
as dyspepsia, constipation, ansemia. Twice or three times a 
week, for half an hour or longer, get the neck of the uterus in 
a speculum, pull it well down, having previously saturated 
some ozonized clay, made into a creamy mass with a little 
water, and incorporated into it cotton-wool, which, introduce 
through speculum right against the neck, allowing it to remain 
during the above period, then withdraw, and wash out with 
vinegar. The ozonized clay dissolves, or disintegrates the lymph 
or cartilaginous matter. Then three times a day until next 
application, vaginal injections of borax, or soapsuds (Castile), 
or chlorate of potassa, and repeat. If it produce no irritation, 
it might be used every other day. 

Dilation, by means of sponge-tents, sea-tangle, and metallic 
and rubber dilators are worse than useless, setting up more 
irritation and additional obstruction. Those expanding instru- 
ments may produce no bleeding, but they are very destructive, 
and if often repeated are most harassing to the patient, and 
invariably after their use the canal returns to its former size, 
even a little narrower. There is no good in either slow or rapid 
dilatation, and even the new method of dilating, lacerating, 
tearing, by divergent blades, is useless ; there is danger of 
irritation, if not of metritis, pelvic cellulitis, or peritonitis. 

Incision is the best plan, as it gives rise to no suffering, gives 
a sure result, and is free from danger, if properly performed, 
and rapid. This is best performed by a pair of scissors, made 
for the purpose, one blade terminating in a probe-pointed end, 
which enters the os; the other by a hook, which seizes and 
fixes the vaginal portion at the point desired. One stroke of 
the scissors divides the intervening tissue in a straight line. 
The proceeding is then repeated on the other side of the os, 
and the operation is then completed. There is a tendency to 
contract again even after that. To meet this, there should be 
a slight nick made of the internal os, just sufficient to divide 
the mucous membrane and some of the superficial circular 
fibres of the muscular coat. This will allay spasmodic sphinc- 
teric action. The incision should be no greater, because it is 
superfluous, and even dangerous. At the mouth of the inner 
neck there are bloodvessels in profusion, and of considerable 
size. Large veins, without valves and small arteries, gap at 



518 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

the uterine level, and are apt to bleed very profusely if uterus 
is cut into. A piece of lint, saturated with the juice or extract 
of hemlock bark, is to be inserted between the cut edges, and 
patient kept in bed under opium. 

If the patient and friends are willing, the best plan, if the 
suffering is great, is to perform the operation at once, as it is 
only a waste of valuable time to exhaust the usual list of 
remedies on her first. 

MENORRHAGIA. 

Profuse menstruation, an abnormal increase in the catame- 
nia, in quantity and in frequency. It is called menorrhagia 
when the menstruation is copious, the catamenial period being 
prolonged, the interval diminished, the quantity of blood dis- 
charged excessive. Metrorrhagia is a term used to describe a 
copious and continuous flow of blood during the interval, not 
necessarily associated with menstruation, but more frequently 
blended with tumors, polypus, cancers, and retained products 
of conception. The uterus is the only organ in the body from 
which blood flows at stated intervals. So long as it does not 
exceed four ounces, and occurs only every twenty-eight days, 
it is normal. 

Causes. — As the uterus is freely supplied with branches of 
the great sympathetic, it may be due to grief, sorrow, worry, or 
excitement, giving rise to relaxation of uterine tissue. Repeated 
abortions devitalize the uterus, under which it loses its con- 
tractility ; besides, wearing sponges, rings, pessaries, and exces- 
sive sexual intercourse, all impair its vitality and bring about 
an excessive flow. Debility is a common cause, whether it be 
that of disease, such as tuberculosis, Bright's disease, affections 
of spleen, or long nursing, or over- work, or lifts, strains; any 
inordinate excitement near period. It may be a symptom of 
metritis, uterine or ovarian tumors ; of pregnancy, when the 
after-birth is over the mouth of the uterus ; cancer of uterus, 
polypus, moles, displacement of uterus, and a variety of other 
causes. 

The symptoms are the excessive flow, with debility and 
anaemia. 

Treatment. — During an attack, enjoin rest of body in recum- 
bent position in bed, head low, foot of bed somewhat elevated. 
With this horizontal rest, ease of mind, no hot drinks or hot 
food, and the patient is not to get up for either urination or 
defecation, for the blood pressure is greatly increased by stoop- 
ing or straining. Diet to be nourishing — beef essence, milk and 
lime-water, eggs, toast. 

As to medicines, the best is sulphuric acid in the mixture ; 
sulphuric acid, turpentine, and alcohol, administered frequently. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 519 

It acts promptly. If the bowels are constipated, the aromatic 
sulphuric acid could be combined with the saline mixture, in 
fifteen-drop doses, and repeated frequently, as no injury is done 
if the saline acts upon the bowels. The sulphuric acid acts 
quickly. It can be given in frequent doses. 

There is a great objection to the use of ergot ; it may be a 
good styptic, it may act well on lumbar portion of cord as a 
stimulant, and thereby contract the uterus, but its faculty of 
causing embolism renders it a bad drug when the heart is 
rendered irritable by loss of blood. 

The beneficial action of digitalis is most decided ; it slows 
the heart, astringes the bleeding vessels, braces up a bleeding 
womb. It should be given in small doses of eight drops every 
two or three hours till pulse reaches sixty. 

Oil of erigeron does not compare favorably with either gallic 
acid, barium, or alum ; with aromatic sulphuric acid, it is over- 
rated by a class of ignorant empirics. 

One of the most powerful local means of aiding a renewal of 
life in the uterus, and inducing contractility, is dry heat, in any 
light vehicle, as chamomile flowers, bran, hops in bags or pil- 
lows, applied over the uterus and \ulva hot. The old doctors 
swear by cold, but cold water, or ice either, over pubes, or up 
vagina and rectum, is positively injurious. If these means 
fail, resort at once to a plug; in the unmarried it is difficult 
sometimes to insert, but in married women there is no difficulty. 
A sponge answers the purpose most admirably, or several small 
ones ; they may be saturated with a solution of cabolic acid, or 
tincture of iron, or vinegar. 

The bleeding surface could easily be reached by injecting 
the uterus with carbolic acid, or perchloride of iron in solution, 
but it is very liable to be followed by bad results ; even injecting 
and immediately withdrawing the fluid is not to be recom- 
mended. The syringing or swabbing out vagina is of no utility 
for the haemorrhage; only good for comfort and cleanliness. 

When there is no clot or debris of placenta in the cavity of 
uterus, the above is usually sufficient. 

During the two or three weeks that intervene between the 
attacks, the patient should be placed upon the compound vibur- 
num, so as to strengthen up the uterus. Meantime, remove all 
causes, if possible, and then the general remedies should be 
two of the following, changed weekly, and persevered with : 
Compound tincture cinchona and nitromuriatic acid ; aromatic 
sulphuric acid and quinine ; glycerite of kephaline, port wine, 
and Peruvian bark ; teas of life root, helonias, and beth root ; 
moderate exercise, best of diet, flannel clothing. 

Other Remedies sometimes Used. — The mother's cordial is often 
of great utility ; so is the fluid extract of stylosanthes. As a 



520 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

uterine invigorator, the kurchicine may be used in all stages 
of haemorrhage from the uterus, and in all the varied sympa- 
thetic affections to which that small, but all-governing, omni- 
present organ is liable. 

INFLAMMATION OF THE UTERUS. 

Inflammation of the substance of the uterus, or, as it is 
termed, metritis, may exist in an acute and chronic form. 

(1.) Acute Metritis. — It may involve a part or the entire 
organ ; rather a rare disease in unimpregnated uteruses, but 
very common associated with impregnated states. 

Causes. — The causes of this condition of partial death are, 
exposure to cold, damp, and excitement when menses are on ; 
shocks of all kinds, falls, blows ; irritation from sponges, rings, 
and pessaries ; abortions ; violence from the instrument, as a 
whalebone, knitting-needle, in performing the act, and in the 
subsequent non-expulsion of all the membranes and clots; lin- 
gering labor, tedious and painful violence from instruments in 
delivery ; the use of emmenagogue drugs, as savin, tansy, 
aloes, ergot; the use of injections. It is doubtful whether or 
not, in very highly civilized women, it may be brought on by 
grief, worry, passion. Poisons, as the imperfectly-washed hand 
of an uneducated physician in removing the placenta, or pieces 
of the placenta ; or in administering ergot erroneously, causing 
the uterus to contract ; or a clot, or coagulum, which excites 
the inflammation ; gonorrhoea, the forcible entry of large hands. 

Symptoms. — Should the shock come on the uterus during 
the menstrual period, or during the lochial discharge, the flow 
is suddenly arrested, and this will also happen in hsemorrhagic 
congestion. Simultaneously there is sharp, lancinating pain 
in the uterus, followed by rigors, and a fever of a high grade. 
Patient lies on back, knees drawn up ; features sharpen and 
become anxious ; eyes look sunken ; tongue coated, pulse rising ; 
great tenderness over uterus, a sense of fullness and weight. 
There is throbbing above pubes, in groin, and perinasum; 
great pain in sacrum, irritable bladder and rectum. Either 
constipation or diarrhoea; if the latter, tenesmus, which is 
troublesome. Usually nausea and vomiting, which is great or 
persistent if the outside covering, or peritoneal coat of uterus, 
is involved. The os uteri, to the finger, is hot, congested, patu- 
lous, sensitive ; to the eye, it looks of a scarlet redness. The 
secretions of uterus acid and acrid ; usually after twenty-four 
hours there is a watery discharge, then bloody, or sanguineous, 
mucous, and serous; pains become acute and bearing-down, 
intermittent, cutting, but at all times the uterus is the seat of 
pain, which is aggravated by pressure of the hand, or bed- 
clothes. This pain extends to perinseum and front part of 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 521 

thighs. If case does not ameliorate, symptoms assume a typhoid 
form. Acute symptoms rarely last over seven days. Recovery 
may take place when the damage is not great, and the patient's 
affections not blasted. 

In unfavorable cases abscesses form in the structure of the 
uterus, or other tissues, as the pelvic, areolar tissue, peritoneal 
membrane ; substance of liver and stomach becomes involved, 
and gangrene sets in ; or, in another class of cases, it may leave 
chronic inflammation, or enlargement, or induration of uterus, 
labia, and a muco-purulent diarrhoea. 

It may come on at any time if violence is inflicted. After 
parturition, a lady is not quite safe from an attack until after 
five or six weeks. It is exceedingly common and very fatal, 
and with very ordinary care it might be rare. Ladies, edu- 
cated and well trained; should be the accouchers, instead of 
gaunt, egotistic males, of uncouth habits, filthy and ignorant, 
with their elephantine fists. There should be a prohibitory 
enactment that no lecturer in a medical college, or hospital, 
should attend lying-in cases. All charlatans or empirics should 
be severely dealt with for instructing ladies in the dreadful act 
of foeticide, which is so common. If these were duly attended 
to, metritis would be as rare in the United States as in other 
countries. 

Treatment. — Formidable as metritis generally is, still, if 
seen early, much can be done to aid recovery. Suffering is 
much relieved by the recumbent posture and complete repose. 
Commence at once with opium and tincture of green root of 
gelsemium — half a grain of opium every half hour, with a few 
drops of the gelsemium (same as in peritonitis, pushed to narcot- 
ism). If we delay, or don't come right up to the mark of ener- 
getic treatment, the patient will die ; don't hesitate ; aconite 
does well, combined with gelsemium; excite an action on the 
skin with an infusion of asclepias, or boneset, or jaborandi ; mus- 
tard over pubes for an hour, then followed with hot poultices of 
linseed and opium ; keep patient on back, hips elevated ; ene- 
mata of linseed tea, with tincture of opium, irrespective of 
diarrhoea or constipation, twice a day ; injection per vagina, of 
the same, or else an infusion of chamomile and carbolic acid, 
thrice daily ; dry heat to vulva ; hop bags. If there is the debris 
of a placenta in the uterus, then that organ should be washed 
out with chamomile and borax, or carbolic acid injection once a 
day. The great aim in the treatment of the case is narcotism; 
the opium relaxes neck of uterus sufficiently to permit the es- 
cape of clots or other bodies. If there is much distressing 
tenesmus, and pain in the sacrum, suppositories of belladonna 
and opium should be used. 

Indeed, whatever the cause, from shocks, fright, lingering 



522 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 



labor, or violence, or whatever the symptoms may be, they can 
often be very successfully combatted with the opium and gel- 
semium ; under those drugs the inflammation soon subsides, 
becomes tractable and manageable. Great care should be exer- 
cised lest abscess takes place, and it is well as the active indi- 
cations subside, to begin with small doses of quinine and anti- 
septic drugs. 

The period of treatment is so short, that if the patient can 
be tided over the seventh day, the condition of death, at least, 
may be obviated. Nourishment must be meagre, and increased 
as recovery progresses; otherwise, if patient do well, the treat- 
ment of chronic metritis must be followed out. She must be 
careful not to get about too soon, as indiscretion may lead to a 
relapse. 

(2.) Subacute and Chronic Inflammation of the Uterus 
— This consists in a low grade of irritation, either of the neck 
or entire body of the uterus, with effusion of lymph, which 
produces enlargement and induration. 

Causes. — It may follow an acute attack, or be brought about 
by musturbation, tight-lacing, which causes local plethora, or 
engorgement, or frequent miscarriages, or abortions ; wearing 
sponges, pessaries ; whalebone, knitting-needles, recklessly used ; 
gonorrhoea, excessive coition, cold, fright, and a sudden arrest 
of menses, or suppression ; use of irritating injections ; emmena- 
gogue drugs. 

Symptoms. — There is languor, lassitude, debility, pain in 
head and back, accompanied by a sense of weight at bottom of 
abdomen ; a bearing-down ; aching in thighs and hips, with 
severe griping pains in uterus, which is very sensitive to ex* 
ternal pressure ; there are heats and colds, or slight febrile at- 
tacks ; loss of appetite, constipation, difficulty of breathing ; 
and the headache is often intolerable. To the finger, neck of 
uterus is very tender, and has more heat than the surrounding 
parts ; to the eye, it is a little redder, but considerably thickened, 
and there is leucorrhcea. The plethora or congestion of the 
uterus, with augmentation of bulk, causes it to descend, and 
produces some abdominal swelling. This increase in size and 
weight is due to relaxation of its tissues, and they being filled 
up with serum, lymph, blood, now grave changes take place, 
owing to the lost contractility and engorgement ; its functional 
activity is entirely abolished ; there is inertia, and the organ is 
predisposed to organic changes. The changes are not uniform, 
they depend often on conditions, as the transition to puberty, 
confinement, or forced celibacy in virgins, or mental states ; 
engorgements, indurations, ulcerations, are frequent results. 
These conditions are much aggravated if the chronic inflamma- 
tion occur late in life, for then if the germs of tubercle, or cancer, 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 523 

or any dyscrasia lurk in the system, it will be likely to mani- 
fest itself. In chronic metritis there is apt to be bladder trouble, 
rarely pain in sacrum, but possibly some pain if stools are 
hard. The entire train of symptoms of hysteria, in addition 
to the above, may be present. It may last a long number of 
years. The menstrual flow is usually excessive or may come 
on several times during the month. 

Chronic inflammation of the uterus is one of the most com- 
mon diseases among modern females, and renders their whole 
life a complete misery ; and even if in mild cases they should 
marry and pregnancy take place, miscarriage at four and a 
half months will inevitably take place, owing to the stretching 
of the indurated fibres at neck, as the body expands, the irrita- 
tion being carried to the fundus, and thus contractions are 
induced. 

Treatment. — Patients suffering from this very chronic dis- 
ease are usually able to be about, and are often engaged in their 
accustomed duties, although suffering greatly. If they are un- 
able to rest a month or two, it renders the process of cure very 
difficult, because rest in the recumbent posture, in bed, with 
elevation of the pelvis, is one of our main standbys. The re- 
cumbent posture is always to be preferred to sitting, and gentle 
walking to standing still. When menstruation is absent, daily 
bathing, shower bath, if possible, with hip-bath thrice daily ; 
the vagina should be syringed out three times a day with demul- 
cents or emollients, as linseed tea, infusion of marsh mallow, 
slippery-elm, or chamomile flowers ; and as the case improves, 
alkaline injections, as soapsuds, borax-water, chlorate and per- 
manganate of potassa ; the temperature that is best is slightly 
tepid ; both bathing and injections to cease during the cata- 
menial state, and when that is over to be resumed. Flannel 
clothing ; bowels to be kept open once a day with cascara; the 
appetite to be stimulated with tonics ; the very best of diet — 
beef, mutton, game, poultry, boiled white-fish, eggs, milk, coffee. 
If digestion is faulty follow with pepsin. Then place patient 
upon alteratives and tonics, general course, with a class of rem- 
edies bearing more especially upon the uterus. 

The alteratives should be administered two hours after meals 
and should consist of one of the following for a week ; then 
another, selecting the two that does the most good, using them 
in alternate weeks : Iodide of potass in compound syrup of Phy- 
tolacca, compound viburnum, compound stillingia, iodide and 
bromide of potass, macrotys in compound yellow dock. 

Tonics before meals, selecting from the following : Glycerite 
of ozone, glycerite of keptaline, ozone-water, compound tincture 
of cinchona and nitromuriatic, aromatic sulphuric acid and 
quinine, port wine and Peruvian bark. 



524 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

Special Remedies. — Beth root, life root, helonias ; fresh in- 
fusions daily, drank freely- ; pastiles of iodide of potass and bel- 
ladonna every night; mother's cordial. 

Chronic Catarrh of the Neck of Uterus. — Is the most com- 
mon of all diseases that afflict modern women. Catarrh of 
the neck of the uterus, called by the physicians ulceration, so 
as to make it appear a formidable affair, and frighten their pa- 
tients. It is true the disease is chronic, but erroneous state- 
ments regarding it are unnecessary. 

In this affection the mucous membrane is swollen, red, and 
bleeds easily, and exudes a muco-purulent fluid or pus. This 
can be readily seen. The mucous membrane has a punctate, 
granular appearance ; its papillae are often denuded, and only 
affects the neck, which is distinct from the body of the uterus, 
and constitutes a large, open gland, which is liable to catarrh. 
The disease is of the greatest importance, on account of its fre- 
quency, being the most common. 

Catarrh of the neck is caused by sexual excesses, wearing 
sponges, rubber tents, childless marriage, abortion, full-time 
delivery, cold, rheumatism, gout, gonorrhoea, suppression of the 
menses, occupations, masturbation and other forms of irritation. 

Symptoms. — The ordinary symptoms are pain in the back, 
about the base of the sacrum, which is the common seat of 
cervical pain ; pain down the thighs ; a felling of weight about 
the rectum or lower part of the belly, and a variety of reflex 
symptoms, as headache, languo^, and a train of indescribable 
sensations. What chiefly attracts the patient's attention is the 
extraordinary discharge, leucorrhcea or whites being profuse, 
or otherwise of a thick, yellow, viscid color, imparting a dirty 
grayish-yellow stain, varying from the healthy crystalline mu- 
cus to yellowness or greenness, or thick, ropy, yellow pus. 

A white, milky discharge cannot be called morbid ; it is the 
vaginal mucus in excess, and occurs in weakly women, after a 
long walk. A glairy, albuminous crystalline discharge can 
scarcely be called morbid, as it comes from the neck, when the 
patient suffers from extreme debility ; but a yellowish, greenish 
dischage indicates disease. Here one speculum examination is 
necessary, and it should be made by the duck-bill speculum, in 
the presence of some lady friend or the husband. The mirror- 
glass speculum shows the disease most beautifully, if there is 
any, and the attendant can see it. No other speculum examina- 
tion is necessary. The patient can now, in nearly all cases, 
manage her treatment successfully ; remove the cause, if pos- 
ible. She should be placed upon alteratives, as saxifrage ; and 
uterine tonics, as the mother's cordial. Or, the vagina should 
be injected with borax or permanganate potass injection thrice 
daily, for cleanliness ; one injection of the ozone et chlorine 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 525 

fluid, performed by the patient herself ; then the borax and 
golden seal injection should be used while the monthly period 
is absent. The use of astringent washes, as oak bark, or alum are 
injurious, because they irritate. No cauterization is necessary. 
The whole treatment is simple, and any lady of average 
intelligence, with a good Crescent syringe, with the lotions 
or washes enumerated, can readily cure herself of an affection 
which years of treatment and innumerable speculum examina- 
tions fail to relieve, and thus save her money, and often her 
affections. We deprecate this uterine speculum business, or 
trade, or prostitution, as we do this uterine massage ; each 
having a special object in view — the alienation of her affec- 
tions and emptying of her purse. 

ULCERATION OF THE NECK OF THE UTERUS. 

A breach of continuity of, or on, the neck of the uterus may 
be the result of some injury, but more generally it is the result 
of inflammation, congestion, or effusion of lymph. It usually 
takes place about the neck. It is a condition not nearly so 
common as is imagined. It is true, chronic inflammation, with 
congestion, catarrh, and thickening of the neck, is very common, 
but comparatively few terminate in ulceration, — few cases in 
which the lymph breaks down. This subject of ulceration of 
the os uteri is a stigma upon the medical profession, so called. 
In order to explain ourselves we shall deviate from the subject 
a little. The medical profession in the United States are a 
pack of knaves and vultures, let loose with little brains, and 
a skim-milk education, superficial in the extreme, to prey upon 
the community. They are destitute of an education, because 
they have not brain capacity to receive it ; and if they had, 
they have no teachers capable of imparting it ; besides, most of 
them are but imperfect scholars in ordinary branches, and are 
destitute of all the qualities of gentlemen. Those human vul- 
tures are so numerous, that in all our large cities or towns there 
is one to every two hundred and fifty inhabitants. They must 
live ; and the first thing that concerns a newly-fledged M. D. 
is to procure a uterine sound and speculum, and on those he 
places his reliance for future success and fortune. With this 
he becomes the great moral force of the profession, and stamps 
his prestige upon the page of time. Ladies, married or single, 
are the prey of the viper. If he is consulted about a headache, 
indigestion, defective vision or hearing, or even in-growing toe- 
nail, there must be a vaginal examination, as there is something 
the matter with uterus. This is done every time anything is 
wrong. It is pronounced an obscure case ; another introduc- 
tion must be made, and another ; her affections must be alien- 
ated to the scoundrel, and thus many loving wives and good 



^^■i^^M 



526 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

daughters are made his victims — he becomes the social ruin of 
families. 

The knaves, or charlatans, even coin new names for trifling 
maladies, and invent diseases. Once they get a grip, they keep 
on with endless examinations, speculations, applications, and 
treatment, and continue on for months or years at this nefa- 
rious business; and then, by some accident, the patient is 
removed from his care, she becomes quite well, and has no 
further need for speculum, pessary, or caustic. 

The older members of the profession are to blame for thus 
letting loose annually such a horde of vultures. 

Women are sensitive and imaginative, know little of physi- 
ology, but feel keenly any ache, pain, or irregularity, and 
attach more importance to it than there is any need to. So, 
if she has dyspepsia, or dysmenorrhea, and a slight bearing- 
down, she is much impressed, and consults one of those mounte- 
banks ; her fate is at once sealed, by the designation "ulceration 
of the neck of the uterus," when nothing is the matter but 
fatigue. It is the fashion, they live by it, it is their bread and 
butter. Poor lady, three times a week she trudges to his office, 
and has his applications applied for a disease that does not exist, 
and, if it did, should be cured without such a mess of degrada- 
tion. This is an every-day game. 

We have another class, meaner still, who go for ulceration and 
displacement. This class assert that there is scarcely a woman 
living whose uterus is where it ought to be. It is antiflexed, 
retroflexed, or verted this way or that way. An examination by 
speculum must be made; and as he gets a large percentage from 
some unprincipled "uterine supporter" patentee, or manufac- 
turer, there will be a variety of contrivances tried, but none 
answer till his favorite is reached ; and, oh ! the fitting-in, the 
adjusting and readjusting, in order to cure headache, irritation 
of the bladder from uric acid, or pretended albuminuria, and 
a thousand other ills that do not exist ! 

Now, where this is done by an educated gentleman, a Chris- 
tian, one who knows what he is doing, and what difficulty he 
is dealing with, if there be one, much good may be accom- 
plished ; but when imitators, pretenders, rascals, go at it for 
cash, nothing but harm follows. With these fellows there are 
muddling and meddling of the most disreputable kind, and 
patients get tired of it, their money and patience become ex- 
hausted, they give it up ; and if there is something the matter, 
become chronic invalids, and are a nuisance to themselves, 
relations, and friends. 

But we will not digress further. 

In all cases of chronic inflammation there should be no let 
up in treatment until the thickening of the neck, produced by 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 527 

effusion of lymph, is removed by alteratives, alkaline vaginal 
injections, and pastiles of iodide of potass. 

(1.) Simple Ulcer, or Abrasion. — An excoriation, or erosion 
of the lips of the neck of the uterus, is the simplest form of 
ulceration. The epithelium is simply removed from the part; 
the villi, with the fine net-work of capillaries, can be felt, vel- 
vety to the touch, or seen by the speculum ; there is no redness 
of any moment. 

Symptoms. — There is a general depression of the health ; 
headache, and languor ; leucorrhoea, pain in pelvis and sacrum, 
irritation of ovaries, bearing-down, aching in thighs, indiges- 
tion, flatulence, with irregular action of bowels. Menstruation 
is likely to be disordered in some way. 

Treatment. — Regulate bowels with cascara, or some mild 
agent ; stimulate the appetite with tonics ; prescribe best food, 
beef, mutton, poultry, milk, cream, eggs, fish, etc., and, if diges- 
tion is faulty, pipsin ; tonics before meals, as port wine and 
Peruvian bark ; compound tincture cinchona and mineral acids ; 
sulphate quinine and aromatic sulphuric acid; gentian and 
collinsonia; and alteratives, as ozonized phytolacca, compound 
viburnum, and iodide potass. 

Locally, after it has been ascertained to exnt by one specu- 
lum examination in the presence of a mother or husband, no 
more are necessary. Neither is the use of caustic, or other 
trash, of utility. The patient can now accomplish the cure 
herself. If married, sexual congress should be held off for a few 
weeks. Then begin with hip-baths, thrice daily ; vaginal in- 
jections, tepid at first, then gradually colder and colder, till the 
ordinary temperature of water is reached. Before using the 
medicated injections, it is well to wash out with Castile soap 
water, the tube of the syringe not to be inserted over two 
inches; patient sitting on a chamber, with medicated fluid 
before her, which is to be thrown up with force by the active 
pressure of the bulb of the syringe. The injections might with 
benefit be changed every three days, and should consist of 
solutions of borax, chlorate and permanganate of potass, lime- 
water, and tincture of iodine ; and, after two or three weeks, 
astringent ones are to be introduced alternately, as infusions 
of oak bark, white pond lily, witch hazel, alum. To hasten a 
healing process, after retiring to bed, a pastile to be inserted, 
consisting of opium and borax, hazeline and tanin, bayberry. 

In this simple manner any lady has her rapid recovery in 
her own hands, and she will soon recognize it in returning 
health and a disappearance of the symptoms, especially the 
discharge. 

(2.) Irritable, or Inflamed Ulcer. — This is deeper-seated, 
involves the lips, but is vascular and red; the loops of the 



528 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

capillaries have given way, and there is an excavation. It is 
sometimes quite extensive in persons whose vital forces are 
feeble. 

Symptoms. — All the symptoms are much aggravated, more 
debility, even mental depression ; the leucorrhceal discharge is 
profuse, and muco-purulent, and greenish ; stains linen greenish ; 
great headache, tongue coated, no appetite, anaemia, neuralgia; 
dirty, sallow hue of skin ; bowels irregular, usually constipa- 
tion; pain in the back, hips, and thighs, aggravated by exercise ; 
reflex irritation of bladder, rectum, and breasts. There is often 
menorrhagia in this variety. 

Treatment. — The same course of treatment as for the simple 
form, with the exception that it wants to be carried out with 
more vigor ; secretions active ; alteratives and tonics. 

(3.) Rodent Ulcer. — In the simple, or inflamed, or deeper- 
seated ulceration, there is found in the discharge the living 
germs, bacteria and amoeba, which render them communicable 
diseases to males if sexual intercourse is not avoided ; but in 
the "rodent form," the micro-organism, oidium albicans, is pres- 
ent in large colonies, so that it is invariably to be regarded as 
a severe disease ; one associated with a breaking-down of vital 
power, and not common in females who are well taken care of, 
or under thirty-five years of age. 

Causes. — Irritation, over-crowding, meagre or insufficient 
food, filth, general breaking-down of vital force. 

Symptoms. — It is to be regarded as a perforating, eating 
ulcer, with a bloody exudation ; ulceration gradually and slowly 
extending. As it eats away, burrows, and perforates, complaint 
is made of heat, pain, and discomfort ; thin, watery discharge 
streaked with blood. The constitutional symptoms are those 
of great prostration ; headache, want of appetite, pallor, indi- 
gestion, constipation, great physical weakness ; pains in back, 
thighs, hips ; burning pain in uterus, and attacks of haemor- 
rhage. On examination, an irregularly-shaped, eating ulcer, 
with ragged or indurated edges. There may be several ; the t y 
all look excavated. They may be dry, or glossy, but there is 
always blood dripping from their edges. When vital force is 
very low, they may eat away the neck and body of the uterus, 
and give rise to dreadful hemorrhage. It is often mistaken by 
the inexperienced for cancer. It often destroys life, if not seen 
to and treated correctly before it eats into uterine vessels. 

Treatment. — In the name of humanity, of good sense, and 
common decency, we protest against the modern treatment of 
rodent, or phagedenic ulceration, with such useless drugs as 
nitrate of silver, caustic potassa — drugs that are totally unneces- 
sary and uncalled for in the local applications in uterine ulcer. 
If a caustic must be used, why not use the best, by first swab- 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 529 

bing or washing out the uterus, and then touching with nitric 
acid, C. P. We repudiate caustics as barbarous, and unneces- 
sary, when we have such invaluable antiseptics as ozone et 
chlorine, which could be used once every week or two, and 
followed by milder ones, four or five times a day. This prepa- 
ration, thrown up the vagina, produces a perfect revolution in 
the ulcerated parts ; it destroys the disease-germs that are caus- 
ing the eating; stimulates the sound tissues, so that they put 
on a healthy appearance. The injection of the ozone et chlorine 
once every week, or two weeks, is most efficacious ; and in addi- 
tion, the first day or two, linseed-tea injections every two hours, 
and then injections of borax and golden seal, gold thread, and 
chlorate of potassa, or bayberry, lime-water, and tincture of 
iodine, every three hours ; pastiles and suppositories of opium 
and belladonna. Alteratives and tonics, as in simple forms, 
with glycerite of ozone, chloride of lime, permanganate of potass, 
and the most nourishing food. 

(4.) Syphilitic Ulceration. — There may be chancres on the 
os or neck, and colonies of germs lodged about the labia of the 
uterus, within the canal of the neck on the upper and lower sides. 

Symptoms. — The copper-colored appearance of ulcers and 
mucous membrane; thickening and induration; the muco-puru- 
lent discharge is excessive from both uterus and vagina ; patches 
of abrasions, or ulcers, are to be seen on the labia of the uterus. 
Menstrual function is irregular ; most frequently menorrhagia. 
Besides, there will be syphilitic cachexia, loss of hair, enlarge- 
ment of post-cervical glands, copper-colored mucous membranes, 
pain in breastbone and other bones at night, copper-colored 
eruption, nodes, mucous patches, etc. 

Treatment. — Same as for syphilis, with the local treatment 
for rodent ulcer, which makes short work of the disease. 

UTERINE CATARRH, OR ENDOMETRITIS. 

Catarrhal, or croupy inflammation of the mucous membrane 
lining the internal cavity of the uterus. 

Causes. — Ovarian disease ; frequent abortions ; the irritation 
of instruments ; drugs, as bromide of potassa, sabina, aloes ; sud- 
den suppression of menses from cold or damp ; masturbation, 
mental excitement, torpid liver, tight lacing, gout, rheumatism ; 
incompatibility in married life. 

Symptoms. — It maybe met with in either an acute or chronic 
form, in the acute variety, the skin is dry, hot; general irrita- 
bility, some fever, sallow complexion, loss of appetite, consider- 
able headache, pain in loins and lower part of abdomen, sacrum, 
groin, and inside of the thighs. A sense of great heat and 
fulness about the pelvis, and bearing-down. Bladder very 
irritable ; a desire to pass water every few minutes, which is 

46 



530 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

loaded with uric acid. Diarrhoea and tenesmus, and subse- 
quently, constipation. Tenderness on pressure over ovaries 
and uterus. After a day or two, thick, ropy, tenacious dis- 
charge, which, after awhile, becomes muco-purulent, and is 
tinged with blood, and imparts a greenish-yellow, or greenish- 
red stain to the chemise, or other body linen. There is often 
piles. 

The chronic form is the most common, and runs a tedious 
course, with headache, languor, lassitude, debility ; great men- 
tal depression, obstinate dyspepsia, flatulence, and constipation. 
A sense of weariness, if not pain, about loins, sacrum, groin, 
inside of the thighs, and bearing-down. The discharge now is 
thick, ropy, tenacious ; very abundant, glairy, like white of egg. 
Often, under the microscope, the sarcinse and yeast-plant germs 
can be detected in it. The discharge is most abundant in the 
mornings, accumulating in uterus over night, or after lying 
down awhile ; indeed, in bad cases, after being in the recum- 
bent posture for some time, it will flow right out. The debility 
increases, and a train of other symptoms set in, as hysteria, 
convulsive affections, nausea, vomiting, tympanitis, tenderness 
of breasts, and menorrhagia, if the lining covering the fundus 
is involved. 

Treatment. — The acute form is to be treated with rest, warm 
hip-baths, mucilaginous drinks; open bowels with cascara; 
give aconite, veratrum viride, and sweet spirits of nitre for 
fever. If pain is great, dry heat to vulva and over pubes ; 
pastiles of opium at bed-time. 

In the chronic form, which is often very stubborn, general 
alteratives in alternation with tonics, selecting from the follow- 
ing list one alterative and one tonic every week, and persevering 
with them : Alteratives, iodide of potass in compound phytolacca 
or stillingia, iodide of lime, or tincture of iodine in lime-water, 
glycerite of ozone. Tonics, port wine and Peruvian bark ; com- 
pound tincture of cinchona and mineral acids ; viburnum, com- 
pound collinsonia and gentian ; glycerite of kephaline. Vaginal 
injections, thrice daily of infusions of hydrastis or bayberry, 
with borax ; or injections of solutions of permanganate, or chlo- 
rate of potass, so as to keep the often acrid discharge from 
irritating vagina ; bowels to be kept regular by a suitable dose 
of cascara at bed-time ; treatment to be discontinued during 
menstrual flow. If after six or eight weeks' careful attention 
and use of above remedies, there is no improvement (which is 
a rare event), then it might be well to suggest injecting the 
cavity of the uterus with the solution of iodide of potass, twenty 
grains to four onces of distilled water, tepid, being careful to 
drain off every drop of it before withdrawing the syringe ; 
patient being on back, with legs flexed upwards, when this 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 531 

operation is being performed ; and the instant an unpleasant 
symptom arises, withdraw. It is undoubtedly the most effica- 
cious method of dealing with very intractable cases. It should 
not be resorted to but once in the month between the periods ; 
and it does not often occur that it has to be repeated over a 
few times. A woman suffering from intra-uterine catarrh is 
very helpless, barren as a rock, and still possesses a condition of 
evolution, and will become fertile the moment the disease is 
removed. There is little good here in the use of pastiles, as 
they do not penetrate inwards. Daily bathing, flannel clothing, 
and the best of food, of the most nutritious kind ; gentle exer- 
cise in open air ; recumbent posture when not exercising. 
Avoid malt liquors and sexual intercourse. 

HYSTERIA. 

A peculiar nervous disease that attacks both sexes, but espe- 
cially females between puberty and cessation of the menses. It 
consists in a peculiar, nervous hyperemia, which occurs in 
paroxysms, and simulates other diseases. 

Causes. — It is, or has been, caused by some irritation of the 
genito-urinary organs, as exciting the sexual organs to irritation 
by works of fiction, lascivious thoughts, luxurious living seden- 
tary habits, causing congestion; heated rooms, tight lacing; 
undue excitement of sexual organs, masturbation. The sympa- 
thetic nerve that covers front of the uterus is often involved, so 
that depressing passions may be regarded as a cause ; besides, 
it is a general symptom in all uterine diseases, and is thus caused. 
The patient commonly is of a nervo-sanguine temperment, with 
a weakened reflex centre, involving both cord and bulb; and 
there is, or has been, an irritation in or about the uterus, which 
is, or has been, transmitted to the seat of reflex action. It is 
a genuine nervous malady, of grave importance. It is not 
necessary for a cause that there should exist present irrita- 
tion ; it may have been twenty years ago, but it has left an 
indelible impression on the centres that is easily roused into 
action by the slightest nervous ruffle, or tire. 

Symptoms. — The common charcteristic symptoms are con- 
vulsive movements of the trunk and limbs; beating of the 
breasts with clenched hands ; or tearing the hair or clothes ; 
shrieks, screams, violent agitation ; a feeling of suffocation, as 
if a ball was in the throat (globus hystericus) ; the attack pro- 
bably ending in an outburst of crying, sobbing, or laughter, or 
hiccough. The patient may fall to the ground insensible and 
exhausted ; soon recovering, tired, and crying. The urine is 
of a low specific gravity, 1010, or even less, and may be passed 
involuntarily during the excitement. The portion of the cord 
down to where the sympathetic emanates is chiefly weakened, 



532 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

consequently we find organs supplied with spinal nerves from 
that part exhibiting or simulating disease, as loss of voice, 
cough, pleurisy, consumption, paralysis, suppression of urine, 
and affection of the lower parts. Passive paralysis may take 
place; even increased sensibility of the parts supplied with 
special spinal nerves, as tenderness of uterus, ovaries, and even 
loss of sensibility may take place. The appetite is generally 
diminished ; still it may be decreased, or even depraved, the 
most extraordinary substances being craved and eaten. 

In some cases the expression of the countenance is peculiar ; 
fulness of the upper lips; drooping of the upper eyelids. Abrupt 
in manner. The menstrual flow usually irregular, and there 
is generally leucorrhcea, or some uterine trouble. Symptoms 
are not always feigned ; they may be exaggarated, but there is 
a real morbid condition at the base, and that may be a nerve 
prostration, or nerve tire, from some old disease. A not un- 
common form of hysteria is where they take to the bed. They 
are languid, cheerful, have good digestion, but lie in bed, and 
greatly appreciate the attention of kind, sympathizing friends. 
They are fully convinced that their disease is of the most serious 
character, and involves the spinal cord or womb. Menstrua- 
tion may be normal, or there may be endometritis, with leucor- 
rhcea, or some form of displacement, or perhaps coccydynia. 
Any defect must be rectified, and the case managed on the 
general treatment. 

Many of the confirmed invalids scattered far and wide over 
the country, who have been to one doctor and then another, 
and subjected to all kinds of uterine medication, mechanical 
and otherwise, with no lasting improvement, and have become 
chronic sufferers, a burden to themselves and families, have 
had originally uterine mischief; for we cannot minimize the 
local irritation on the general health, but the cases have drifted 
from their original condition. The pain, the backache, the 
leucorrhcea, the uterine partial death, the difficulty in locomo- 
tion, the disordered menstruation, which are the usual attend- 
ants, have ended in a general disturbance of all the bodily 
functions. The nervous system is profoundly affected, the 
blood impoverished, and the general nutrition at the lowest ebb. 

After the disease has become confirmed, or chronic, there are 
a few prominent symptoms that are well marked. One of the 
most common is wasting of the fatty tissues of the body, com- 
bined with anaemia, loss of appetite. Associated with this we 
often find chloral, morphia, or stimulants resorted to ; exercise 
is abandoned, and the patient becomes confined to the house or 
bed. Her vitality is at a low point ; her emotional or hysterical 
condition craves sympathy, and the whole household becomes 
victims of her morbid selfishness. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 533 

Treatment. — During the fit, or paroxysm, loosen dress and 
corset, prevent injury, and have a free draught of fresh air. If 
she can swallow, teaspoonful doses of either the fluid extract of 
sumbul, or the ammoniated tincture of valerian, at intervals. 
If insensibility continues, cold water douche to head, and ene- 
mata of gum Arabic water and turpentine, and the application 
of ice, or cups, or heat to cervical portion of spine. Between 
the attacks the treatment should consist of a general alterative 
and tonic course of remedies, with daily shower and hip-baths ; 
vaginal injections, and attention to the bowels. If these means 
fail, and the patient has the necessary funds, the following 
treatment should be resorted to in addition : The patient to be 
isolated, or removed from the unwholesome moral atmosphere 
of sympathizing friends ; her vitality renewed by perfect seclu- 
sion and rest ; by a peripheral stimulation of the entire body 
by friction, shampooing, kneading, with a vital nurse, and by 
excessive feeding. This is astonishingly successful if carried 
properly out. We shall enumerate the points in detail : 

(1.) /Seclusion and Rest. — Separate the patient from her moral 
and physical surroundings, which have become part of her 
sickness, and there is a beneficial change ; then absolute rest 
in bed, patient not to be permitted to rise only for the purpose 
of passing her evacuations, and is neither allowed to read, sew, 
or even feed herself, for several weeks, and then to get round 
gradually. 

(2.) Manipulation. — Begin with half an hour, and increase to 
one hour and a half, night and morning, a system of friction, 
shampooing, manipulation, or kneading, the muscles of the 
entire body, sponging off the part operated on with a tepid 
alkaline wash. After the patient has rested about two hours, 
follow up with electricity, the interrupted current, for three- 
quarters of an hour. The poles, armed with wet sponges, are 
to be placed on each muscle of the body, about four inches 
apart, and moved slowly until the muscles contract. Begin at 
foot and go up, and go over every muscle on the superficial 
part of the body. It may be painful and disagreeable, but it 
is of unquestionable utility. The nurse can be easily instructed, 
so as to do it systematically. 

As to the diet, starve her the first ten days, by only feeding 
on milk in small quantities ; and as soon as the natural appe- 
tite is restored under this passive muscular exercise of a good 
number of hours daily, then nourish freely with brain food, 
as animal diet, game, chicken, boiled fish, oatmeal porridge, 
cream, eggs. If such a process as the above is carried out for 
eight or ten weeks, with rigid isolation, there is little need of 
any drugs, for all uterine trouble rapidly disappears. The 
principal of manipulation for so long a period, and so varied 



534 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

i 

daily, carried vigorously out by a trained, healthy, or very 
vital nurse, soon imparts to the nervous system of the patient 
the vital elements that are deficient in brain, cord, and bulb. 
The treatment involves hard work, is very troublesome, and 
requires care and patience ; but as it is effective, nothing should 
debar us in resorting to it. 

UTERINE HAEMORRHAGE. 

This means haemorrhage from the uterus at any other than 
the menstrual periods. This may arise from various states ; 
it may be a symptom of inflammation and congestion ; of endo- 
metritis, of ovarian disease ; of polypus in the uterus, or other 
tumors, or cancerous infiltration. 

It is often the precursor of miscarriage or labor. Occurring 
during pregnancy, it is suggestive of a partial detachment of 
the placenta, or of what is called placenta prsevia, that is 
located over the mouth of uterus. 

After labor it may be due to inertia of the uterus, the organ 
being tired out ; to the presence of shreds of membranes, pieces 
of placenta, or clots. 

Intra-uterine coagula, both in the menstrual and puerperal 
state, are common causes. Puerperal coagula differ from 
menstrual coagula essentially in the time of their occurrence. 
Menstrual coagula may occur at any time during the child- 
bearing period of life, remote from childbirth or abortion. 
Puerperal coagula occur only in the period called that of the 
puerperal state, which is limited to abortion, or childbirth, 
which is covered by a period of one month or six weeks after 
delivery. The retention of a coagulum, or portion of the pla- 
centa, is a common cause of haemorrhage, and there is a con- 
stant risk of bleeding so long as a particle remains. Relaxation 
or inertia is the common cause. Fibrinous polypi are very 
productive of it. 

Treatment (see Menorrhagia). — In cases of pure relaxation 
and dilation of the uterus, sulphate of quinine in mineral acids, 
in alternation with tincture of black snakeroot ; and if these 
fail, wine of ergot should be cautiously administered ; the 
washing out of the vagina, if their is fetor, with tepid water and 
permanganate ; and if all fail, insert the sponge plug, as already 
suggested. The use of hot water for syringing the vagina has 
a much better action than cold in causing a renewal of life, and 
a regaining of lost contractility. 

TUMORS OF THE UTERUS. 

Of all organic diseases of the uterus that manifest them- 
selves during the period of sexual vigor, non-malignant tumors 
are the most common ; and there can be little doubt but that 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 535 

the causes that tend to produce chronic inflammation are the 
same as cause those growths. They may manifest themselves 
in various ways. There may be a general hypertrophy of the 
muscular fibres, with a deposit of fibrin, causing a general 
increase of size; and the condition may progress on and on 
until fatty degeneration is reached — a condition of non-con- 
tractility which gives rise to haemorrhage. 

(1.) Fibroid Tumors. — A condition in which we have an 
excess of fibrous tissue. It may be simply an outgrowth of 
the ordinary fibrous tissue of the uterus; if not an outcrop- 
ping, a deposit. It may be in the form of a nodule, or tumor, 
developed in any part of the uterus ; or it may be effused just 
on the surface, below the peritoneal coat ; or it may be inter- 
stitial, or intra-mural, that is, imbedded in the uterine walls; 
or it may be submucous, or intra-uterine, when in the cavity 
of the womb. 

An excess of fibrous tissue elements in the blood, and local 
irritation, are the causes. 

Sypmtoms. — Very frequently neither important nor well 
marked, as there is neither cachexia nor pain, in front or back, 
or shooting through. When of sufficient size, it encroaches on 
the pelvic viscera, and can be detected over abdomen, or per 
vaginum, or rectum, or by sound. Even if small, it is likely 
to give rise to frequent haemorrhages, difficulty in passing urine, 
or in retaining it; obstruction of the bowels, or constipation, 
haemorrhoids. If it is intra-uterine, the haemorrhage is likely 
to be severe, and to be accompanied with bearing-down pains. 
The sharp, lancinating pain of cancer is entirely absent, but 
there is, nevertheless, a sort of dull, aching, or throbbing pain, 
with a sense of weight and bearing-down, corresponding to the 
size of the deposit, or growth. Enlargement and tenderness of 
breasts, and they often exude serum from the nipple. If unable 
to detect, evacuate bowels thoroughly with oil, and make a 
careful abdominal manipulation and vaginal examination. 

Treatment. — The first idea is to procure absorption. For 
this purpose the general health of patient must be seen to ; the 
best of diet ; the appetite increased and digestion facilitated 
with pepsin ; bowels regulated w T ith cascara ; skin stimulated 
by acid and alkaline baths, with palpation, shampooing, daily. 
Then place patient on ozonized phytolacca, glycerite of ozone, 
ozone-water, iodide of potass, iodide of lime ; and locally, apply 
ozonized clay uninterruptedly above the pubes, a little larger 
than the uterus; confine it, or keep it, in close apposition, by 
a belt or bandage, like a T, pinning the fold up in front tight. 
If the clay causes no redness, let it be on all the time, every 
morning moistening with water, so as to render it soft or pol- 
taceous, or applying fresh clay. As a rule, the first application 



536 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

of the clay should last four or five days. The best plan, how- 
ever, is to be guided by the appearance of skin ; never cause 
redness. 

Two of the above remedies should be given the same week ; 
one before, and other two hours after, eating. To hasten the 
process of absorption, pastiles and suppositories of iodide of 
potassa should be used every night. All remedies but clay to 
be discontinued during menstruation. Haemorrhage and other 
symptoms to be treated on general principles. 

(2.) Polypus of Uterus. — A pear-shaped excrescence at- 
tached, and growing from the mucous membrane of the uterus. 
It may be in the cavity, on the neck, os, or in vagina, or other 
part, by a pedicle, or root, or stem. 

There are three varieties : (1.) Gelatinous, or mucous. (2.) 
Fibroid, pale white, covered with mucous membrane. (3.) Fi- 
broid, fleshy, or placental. The predisposing cause is tuberculse ; 
the exciting cause, irritations, as aboitions, masturbations. 

Symptoms. — Either profuse menstruation, or irregular at- 
tacks of uterine haemorrhage, or a dribbling all the time, or 
even excessive flooding ; leucorrhcea very profuse. If polypus 
is large, there may be irritation of the bladder and rectum by 
pressure. The same condition is likely to give rise to bearing- 
down or expulsive pains, coming on by spells, or worse after 
exercise. The continual loss of blood is a heavy drain, and 
gives rise to debility, loss of flesh in proportion to the amount 
of loss. The polypus can easily be detected in the uterus by 
the sound, or, if on neck, os, or vagina, by finger and speculum. 

Treatment. — If the polypus is in vagina, or on the neck, or 
os, any of the following methods of treatment can be resorted 
to : It can be excised, and bleeding arrested with a sponge, 
proper size, saturated with perchloride of iron ; it can be ligated, 
and allowed to slough off; torsion can be used, that is, it can be 
turned a little every day, thus impeding its circulation, strangu- 
lating it, and allowing it to slough off; or the chain of the 
ecraseur can be applied round it, and crushed ; or, if it can be 
brought into a speculum handy, the ozonized chloride of chro- 
mium can be applied, and cause its instant death without a 
particle of pain. 

If in the cavity of uterus, the os uteri must be dilated, and 
it may then either be snipped off or ligated. 

In order to prevent a recurrence of the disease, the patient 
should be placed upon alteratives and tonics, and the treatment 
for tuberculosis. 

Other symptoms to be attended to on general principles. 

(3.) Cysts of Uterus. — Cysts, or closed sacs, resembling hy 
dated cysts, are often developed in the substance of the uterus 
or beneath internal mucous lining, or under external serous 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 537 

covering. Sometimes one part of the uterine walls is invaded 
with cysts, or small bladders, while another part is infiltrated 
with fibrous tissue, or the ordinary fibroid tumor. These cysts 
give rise to trouble and inconvenience when they attain any 
size, such as leucorrhcea and haemorrhage. If within reach, 
they may be punctured. They, like the others, are unaccom- 
panied with pain ; not infrequent give rise to uneasiness. The 
best treatment is a general alterative and tonic course. 

In order to avoid those three common forms of uterine disease, 
there should be a rigid avoidance of irritation of the uterus, 
either by tight lacing, wearing sponges or pessaries, masturba- 
tion, abortions, irritating caustics of doctors, especially nitrate 
of silver; even certain occupations, as the sewing machine, 
should be guarded against, or other forms that aid in the pro- 
duction of congestion. 

CANCER OF THE UTERUS. 

Cancer ol the womb is becoming a frequent and common 
form of cancer. The cancerous deposit usually begins in the 
neck and proceeds up, and then involves the body. It is gen- 
erally of the acute, or medullary form ; it may begin as an 
epithelial or scirrhus, but this seldom lasts long. Uterine cancer 
most common about change of life. 

Causes. — The predisposing cause is the diathesis ; the ex- 
citing cause is chronic inflammation, relaxation, that enables 
this germ, when once in the blood, to aggregate by affinity in 
a weakened part, and grow. The germ once deposited, uses up 
in its own nutrition the structure of the part, causes atrophy, 
then hypertrophy, and has a very wonderful faculty of growth. 
All the causes, then, of chronic inflammation are to be taken as 
the exciting cause of carcinoma. 

Symptoms. — Cancerous cachexia ; dingy, sallow hue of coun- 
tenance; pearly conjunctiva ; gnawing and sinking at pit of 
stomach ; skin dry ; stools clay-colored ; cancer cells in urine ; 
languor and debility extreme ; pain anterior and posterior over 
uterus ; occasional abundant watery discharge, of a dirty pale- 
green color, always offensive. After a while, sudden attacks 
of hemorrhage. The pain increases ; at first it is simply a 
dart, like a knife, from front to back, occurring usually at night, 
or when patient was fatigued ; it now becomes almost contin- 
uous, and causes great distress. The stomach loathes and rejects 
food ; there is nausea, vomiting, flatulence, and bowels become 
irregular. The mental depression is extreme, the debility in- 
creases day by day, and the body wastes rapidly. The discharge 
from vagina is intensely foetid, the haemorrhages become almost 
constant, the cancerous cachexia is most decided. The uterus 
becomes so filled up with diseased-germs that it is quite im- 



538 



DISEASES OP THE FEMALE ORGANS OF GENERATION. 



movable in the pelvic cavity. The lips of the mouth of the 
uterus become indurated ; nodulated at first, and then great 
excavations take place in them, and the cancerous mass can 
be felt protruding through. Vagina, bladder, and rectum be- 
come all involved, and there are perforations, and openings, 
and counter-openings between those various* organs. Death 
usually takes place from exhaustion. 

Treatment. — Place patient at the earliest discovery of the 
disease upon the general constitutional treatment for cancer, 
and as it is highly contagious and infectious, an avoidance of 
sexual intercourse, and a resort three or four times a day to 
vaginal injections, as lime-water and tincture of iodine ; solu- 
tions of permanganate of potass, or chloride of zinc. 

Relieve Pain with henbane, camphor and lupulin, opium and 
henbane, morphia, chloroform and Indian hemp ; hypodermic 
injections of morphia; use also pastiles and suppositories of 
opium and belladonna. 

After attending to those preliminaries, see to the stomach, 
bowels, kidneys, skin and diet ; coax an appetite with tonics 
and the dantiest kind of food ; follow with pepsin ; give cascara 
to regulate bowels, and attend to skin and kidneys with diu- 
retic drinks and acid baths. For haemorrhage, first, gallic acid ; 
turpentine and sulphuric acid ; alum and sulphuric acid. After 
thus watching and meeting indications very promptly, the 
next point to decide, is, can the germ colony be destroyed by 
local means ? If not too extensive, that is, if it does not involve 
the veins and arteries of the body of the uterus, the ozonized 
chloride of chromium paste could be applied through Race- 
mier's speculum, for an hour, and cause painless destruction of 
the mass. If too large to be admitted into this kind of specu- 
lum, no other should be used. Glass is to be preferred to 
metal, as the ozone is highly corrosive to all metallic bodies. 
If the chloride of chromium cannot be applied, then the only 
other chance for the patient is the application of the ozonized 
clay over the pubes. 

If it is only pessible to bring the ozonized chloride of chrom- 
ium in contact with it its annihilation is certain, and the case 
will recover, for the entire mass of diseased germs will be thrown 
off in a few days. The other treatment, that is, the vaginal in- 
jections and ozonized remedies internally, must be pushed with 
great vigor. In this way, this hitherto hopeless form of uterine 
cancer can be managed most successfully. 

DISPLACEMENT OF THE UTERUS. 

The uterus may be displaced in various ways. The most 
common causes are debility, relaxation, want of tone ; dilata- 
tion of vagina, combined with tight lacing ; lifting, jumping, 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 539 

strains, falls, constipation, indefinite retention of urine, conges- 
tion, tumors, weight increased. 

(1.) Prolapsus and Procidentia. — These two terms are em- 
ployed to designate a descent or falling of the womb, as it ex- 
ists in two different grades. Prolapsus means that condition 
in which the uterus falls below its natural level in the pelvic 
cavity. The term Procidentia is used when the uterus slides 
down and protrudes beyond the vulva. It is simply prolapse, 
or falling, extended in degree, both conditions being the same. 

Symptoms. — Leucorrhoea, pain in the back, sense of weight 
or fulness about pelvis, bearing-down pains. Usually no im- 
pediment to menstruation, or conception, as uterus is generally 
replaced when in the recumbent posture in bed ; irritation of 
bladder and rectum. In prolapsus, uterus found depressed, 
resting on upper floor of perinseum ; in procidentia, a round 
or pear-shaped tumor, with os uteri visible at its centre, is seen 
projecting beyond the vulva. Labia of os uteri, from exposure 
to air and clothing, often becomes excoriated ; vaginal walls 
dry, harsh, cracked or ulcerated. 

Treatment. — Remove all causes, as tight lacing, cough, con- 
stipation, congestion. Regulate bowels with cascara, so that 
stools will be easy and soft ; place patient upon the very best 
of food and tonics, such as Peruvian bark and port wine, the 
viburnum compound, cinchona and mineral acids, glycerite of 
ozone, infusion of witchhazel, or fennel seed, and if menstrua- 
tion is scanty, compound betin pill. First thing in the morn- 
ing, wash out vagina with one of the following solutions or 
washes, using a bed-pan, so as to maintain the recumbent pos- 
ture : Permanganate potass, lime-water ; carbolic acid, and 
tincture of iodine; borax. Pest a few minutes, then inject 
either a solution of alum, or alum and sulphuric acid, or sul- 
phate of zinc, or fluid extract of matico, or oak bark, or infu- 
ston of witchhazel. Before getting up, have a fine silk sponge 
cut in the shape of a small pear, with a silk cord fastened to it, 
which saturate with the last wash used, and then insert up the 
vagina, the broad base upwards and point or pedicle down- 
wards, from which the cord hangs. Then patient to get up. 
The size of this pear-shaped sponge will depend on the capacity 
of the vagina ; it must be large enough to prop the uterus up 
in its proper place. This process of injection is to be repeated 
at noon and at bed-time. The patient can easily draw the 
sponge out herself, which should be thoroughly washed every 
time. After the night injection the sponge need not be inserted, 
but should be laid to steep in borax-water. This is to be re- 
peated every day, changing remedies every three or four da}^s, 
and keeping the patient lying down as much as possible. Cold 
water hip-bath, morning and night, to give tone to the pelvis 



540 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

and its organs, especially the broad ligament. All treatment, 
except the tonics, to be discontinued during menstruation. 

If the case is an aggravated one of procidentia, the uterus 
must be returned, and the same plan pursued. 

Now, if this fails in eight or ten weeks, which is seldom the 
case if patient is faithful, and the injections cold and of proper 
strength, return the uterus, and resort to the radical operation 
of painting seven vertical streaks on the vaginal walls, as pre- 
viously described under Vaginal Prolapsus. This is better than 
humbugging with belts, supporters, plates, pessaries, rings, and 
other trash that irretrievably ruins a woman. Any lady, with 
a very little instruction, may cure herself in a short space of 
time. It will aid matters much if she is freed from all domestic 
care or toil or worry, so that when about she can either walk 
gently, or ride, for the improvement of general health. 

There is still another plan of radically curing, and that is, by 
injecting only one injection, of nearly double strength, of the 
ozone et chlorine injection. This will necessitate a confine- 
ment to bed, as in the case of the vertical streaks with nitric 
acid, but is not near so positive. 

Still another method is suggested, in old chronic cases, with 
thickening of the neck. The antiseptic injections are used as 
above, but the sponge is well cleansed, and then every time it 
is inserted is saturated with the following mixture : Glycerine, 
eighty ounces ; alum, ten ounces ; carbolic acid, one and one- 
quarter ounce. This has a most beneficial effect in stimulating 
the capillary circulation of the uterus and pelvis, and acts as a 
depleting agent, and removes the induration, in so much as it 
drains the blood of its water by its affinity for water. In short, 
if there is any thickening, this kind of medicated sponge effec- 
tually obviates it, and keeps up a drain on the parts, and re- 
duces them to their natural size and healthy state ; and there 
is usually a rapid appearance of improvement in the patient. 
It is only adapted to cases with considerable thickening. 

(2.) Retroflexion and Anteflexion. — Retroflexion consists 
of a bending backwards of the uterus at the part where the 
neck joins the body, so that the fundus is found between cer- 
vix and rectum, the mouth of the uterus being in its normal 
position. The uterus becomes shaped like a retort. In ante- 
flexion we have precisely the same condition of things, only 
reversed, the fundus resting on bladder. 

Symptoms. — If the displacement is not great, there may be 
few symptoms present. As a rule, it is more common in large, 
flabby women whose pelvic capacity is great. If the angle of 
flexion is acute there is considerable suffering; the uterine 
ligaments are unduly stretched, circulation through uterus 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 541 

impeded, and fundus immovably fixed, on either the rectum 
or bladder. 

There is usually great languor, lassitude, debility, dull, wear- 
ing backache ; tenderness about groin and inside of thighs ; 
sense of fulness in rectum or bladder ; pain from sexual inter- 
course; fecundation prevented ; severe dysmenorrhcea ; nausea, 
gastric irritation, loss of appetite. Mental depression and the 
manifestation of reflex irritation or exhaustion, as in hysteria. 
The displacement is readily made out by uterine sound. 

Treatment. — Replacement is to be effected by a thorough 
evacuation of the bowels and bladder; pushing fundus up- 
wards, with the aid of a No. 6 catheter, and strapping catheter 
to the thigh, meantime injecting vagina with ozone et chlorine, 
once, and following with infusion of golden seal and borax, or 
witchhazel and bayberry, keeping bowels very soluble. 

(3.) Retroversion and Anteversion. — In retroversion the 
uterus lies almost transversely in uterine cavity, with fundus 
towards hollow of the sacrum and os uteri under pelvic arch. 
In anteversion the fundus lies on the bladder and os uteri in 
the cavity of the sacrum. 

Symptoms. — General symptoms of nervous depression ; back- 
ache, bearing-down, leucorrhcea. Menstruation not so much 
interfered with but that impregnation may take place. There 
is considerable aching pain in thighs and hips ; there may be 
some difficulty with rectum or bladder. If it occur during 
pregnancy likely to be retention of urine. 

Treatment. — Replacement with the catheter ; a general tonic 
and alterative course of remedies, such as is laid down under 
Simple Displacement, with cold vaginal injections thrice daily, 
and pastiles of tannin and opium at night ; hip-baths ; avoid 
all causes, as coughing, lifting, jumping, straining. 

(4.) Inversion of the Uterus. — This is a condition in which 
the uterus actually turns inside out. It usually happens in 
hurried labor in large, flabby women with a straight sacrum. 
Cases are recorded where it has occurred after the expulsion of 
a polypus. The fundus of the uterus descends through the os 
uteri ; the internal covering of the womb becomes the external 
covering of tumor. 

Symptoms. — Severe nervous shock ; great depression and 
faintness, with bearing-down pains ; nausea and vomiting, with, 
perhaps, haemorrhage. Sometimes the shock is fatal if labor 
has been long and painful. In some cases, when not detected 
at the time of its occurrence, patient may have gone on for 
months or years, suffering from pain in loins, pelvis, poor 
health, anaemia and haemorrhage. 

Treatment. — Place patient at once under chloroform ; then 
on her back, knees drawn up. Then place forefinger of right 



542 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

hand in the left corner of the uterus, pushing it gently but 
perseveringly up, and as the fundus ascends through the neck 
grasp the uterine tumor through the abdominal walls with the 
left. In this way reduction is easily effected. As soon as the 
inversion is reduced, if the uterus does not contract sufficiently 
try cold or heat on abdominal walls, and if this is not sufficient, 
electricity by Faradization should be used, as well as the sponge 
plug, saturated with perchloride of iron. In chronic cases an 
effort at reduction should be made. 

(5.) Sub-Involution of the Uterus. — Very liable to be 
caused by intra-uterine catarrh, or congestion, which has left 
this legacy or weakness of the fundus. 

Symptoms. — Are vey variable ; all the . symptoms of hys- 
teria, with faintings, often nausea and vomiting, bearing-down, 
backache, weariness, languor, etc. Uterus detected large and 
flabby, with fundus depressed. 

Treatment. — General constitutional treatment for uterine 
catarrh should be resorted to, and twice, in the middle of the 
month, between the menstrual periods, the following should 
be done at intervals of a week apart : Insert, if possible, a No. 12 
silver catheter into the cavity of the uterus, so as to dilate the 
neck. Then, having previously prepared a piece of whalebone 
the size and shape of a No. 2 catheter, wrap fine cotton-wool 
around about an inch and a half of its point, bound lightly 
down with a thread round and round, so that it is no thicker 
than what is already through the neck ; then saturate the cot- 
ton on the end of the whalebone with a solution of equal parts 
of alcohol, iodine, and iodide of potass ; withdraw the catheter, 
and quickly insert the whalebone so prepared and medicated, 
up to the fundus of the uterus, moviug it gently around ; then 
remove, dip it in the solution, and re-insert a second time. In 
this way, a large, flabby uterus, sub-involuted, is, in the course 
of a few applications, brought back to its original size, and the 
difficulty completely overcome. Seldom more than three or 
four applications are necessary. It is simple, and there is no 
danger of setting up any inflammation. If there is any diffi- 
culty in introducing the large size catheter, then dilate the 
neck sufficiently for half an hour before the application with 
either the metallic or rubber dilator. 

DISEASE OF THE OVARIES. 

Ovarian disease has recently become most common, owing to 
the numerous morbid conditions of the uterus, with the erone- 
ous and irritating drugs used, the greater frequency of induced 
abortion, the extreme prevalence of the venereal disease ; that 
very deleterious occupation to women, the sewing machine. 
Before its introduction disease of the right ovary was almost 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 543 

unknown; now it is the most common ; if not giving rise to di- 
rect inflammation it produces ovarian dysmenorrhea, or leucor- 
rhcea. 

(1.) Acute Inflammation of Ovary. — A partial death of 
the ovary may arise from a long, tedious, harassing labor; from 
the use of instruments in producing abortion; from the inject- 
ing of fluids into uterine cavity ; from absorption of lochial pro- 
ducts, or other debris ; from the use of caustic to the neck of 
uterus ; from dilatation of the os uteri ; from violence, falls, 
blows ; also from sudden suppression of the menses from cold, 
or wet, or shock ; from gonorrhoea, excessive sexual intercourse, 
or sexual intercourse within six weeks after miscarriage; mastur- 
bation. Usually left side, unless due to movement of right leg. 

Symptoms. — There is the shock, with localized pain over the 
region of theovary, aggravated by pressure or movement, with 
aching or numbness, or pain in the inside of the thighs, with re- 
peated rigors and a fever. The features are anxious, tongue 
coated, nausea, vomiting, pulse frequent and wiry ; great restless- 
ness and loathing of food ; bowels constipated ; urine very scanty, 
scalding, and high-colored ; patient lies on back with knees 
drawn up. In some cases the pain in the ovary is intense, 
causing a bearing-down like labor pains ; in other cases it is 
of a dull, aching character, with paroxysms of occasional sharp, 
lancinating attacks. Besides the intense pain in the ovary or 
gland, there is quite considerable pain in the groin and thigh 
corresponding to affected ovary. Bladder is always irritable. 
The peritoneal covering always sympathizes and often becomes 
involved. Passage from bowels gives great distress, the hard- 
ened fgeces passing along in the distended bowel presses hard 
on the ovary. Besides, the ovary can always be detected ex- 
cessively tender, swollen, or puffed up. If the case is a severe 
one, or treatment inefficient or shilly-shally, it may terminate in 
peritonitis, or in the breaking down of the effused lymph in the 
ovary, and suppuration. If the latter, there will be rigors; 
the pulse will become feeble ; there will be great nausea and 
vomiting, tongue will become red and glazed ; there is weight 
and throbbing in the ovary. In favorable cases abscess will 
burst into vagina or rectum ; in unfavorable cases, into perito- 
neal cavity, giving rise to peritonitis and death. When open- 
ings or sinuses form, the case becomes very tedious, opening and 
closing again and again. 

Treatment. — The moment case is made out, apply turpen- 
tine over affected ovary ; as soon as redness is bright, hot 
poultices of linseed meal ; as soon as redness becomes other, a 
reapplication of the turpentine, or else croton oil, and follow 
with hot poultices and opium. At the same time open the 
bowels with copious enemata of linseed tea and laudanum, 



544 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

and place patient upon opium or morphia and gelsemium, in 
doses often and repeated until there is absolute relief from pain. 
If this does not succeed quickly, introduce pastiles into vagina 
and suppositories of belladonna and opium into rectum. If 
skin does not become moist and be considerably better in a 
few hours, substitute aconite for gelsemium, and with it give 
jaborandi. In addition to the poultices and stimulants over 
ovary, cushions or small pillows of hops, baked in an oven, 
hot over pubes, vulva, hips. If in this manner inflammatory 
symptoms can be held in abeyance for four or five days by es- 
tablishing a renewal of life in the ovary, then begin with the 
iodide of potass with bicarbonate very cautiously ; by and by 
iodide of lime, and later on ozonized glycerine. The irritating 
plaster can be substituted for the more active agents, spreading 
it fresh every morning and applying. The diet all through 
the attack should be meagre, and confined to milk and lime- 
water, and beef-tea ; bowels opened daily with warm enemata 
of linseed tea 

If there are elements of venereal poison in the case, tepid 
injections of solutions of borax, or permanganate, should be 
used thrice daily. 

As the progress of these cases is essentially slow, great cau- 
tion is to be observed in resuming exercise, diet, and ordinary 
mode of life. Even a tonic course, so essential for recovery, is 
best delayed till all pain has ceased. Usual uterine tonics. 

(2.) Chronic Inflammation of the Ovary. — One of the 
most common affections of modern ladies, during the period 
of sexual vigor. Essentially a very chronic disease. It con- 
sists in a low grade of either ovary, or both. 

Causes.' — Suppression of the menses by cold, damp, fright 
or passion. Masturbation, use of sewing-machine ; violence, 
exercise too great, as dancing ; tight lacing ; sexual incompati- 
bility ; excessive sexual intercourse ; producing abortions with 
sounds, whalebone, knitting-needles; retention of puerperal 
products, as clots and pieces of placenta ; the use of sponges, 
pessaries, rings, uterine supporters ; sexual congress within six 
weeks after confinement ; use of caustics ; gonorrhoea ; fictitious 
literature ; rheumatism and gout, etc. 

Symptoms. — There is general languor and debility, an un- 
defined sense of weariness ; a nerve-tire, with a pale, dry, white, 
doughy skin, torpid bowels and irritable bladder, with scanty 
urine, and irritation of stomach, nausea, indigestion, flatulence, 
with decided hysteria. There is a dull, continuous pain over 
the affected ovary, aggravated by pressure, movement. In some 
cases neuralgic shooting pain in addition ; besides this steady 
pain in ovary, there is also tenderness in the groin, in the sa- 
cral region and in the upper part of the thighs. There is trou- 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 545 

ble of some kind with the menses, usually scanty and painful. 
Pain in sexual intercourse ; likely to be some puffing or swell- 
ing of ovaries ; also tumefaction and tenderness of one or both 
breasts. Nymphomania is a common symptom, and it may 
even merge into a more decided form of insanity, or peculiar 
strangeness of conduct. Often in defecation, if stools are hard, 
pain is great. In all cases the ovary can be detected sensitive 
or tender, either over ovary, or by vagina or rectum. 

Treatment. — For three weeks during every month the treat- 
ment can be carried on with vigor, but during menstrual period 
it must be entirely suspended, with the exception of local stim- 
ulation over affected ovary. The points to observe are — ascer- 
tain the causes, and remove them by daily bathing, hip-baths ; 
regular evacution of bowels ; gentle walking exercise ; warm 
flannel clothing ; excite appetite and give best of food, followed 
by pepsin ; solid diet of animal food, white-fish, oatmeal por- 
ridge and cream, eggs, etc.; avoid slops. Then general course 
of vegetable alteratives and tonics, such as compound syrup 
Phytolacca and iodide of potass. Iodide and bromide of potass 
in the viburnum compound, or in stillingia compound ; iodide 
of lime ; port wine and Peruvian bark ; sulphate quinine and 
aromatic sulphuric acid; glycerite of ozone, ozone-water. 
Besides these, the following acro-narcotics have a remarkable 
sedative action on the ovaries: Tincture digitalis, tincture 
belladonna, tincture cimicifuga. 

Those drugs have an effect to soothe and even prevent the 
evolution of the ova if long continued. Pastiles and supposi- 
tories every night at bed time of belladonna and opium, if 
necessary. The above can be so regulated as the tonic can be 
given before meals, alteratives after, and the other remedies 
between. The irritating plaster to be kept continuously applied, 
keeping an open sore about the size of a hen's egg. It will be 
necessary to keep up this alterative and tonic treatment for some 
months, and while so taking treatment the vagina should be 
washed out at least twice a day with tepid water and borax, or 
an infusion of golden seal and borax or sage tea. 

(3.) Ovarian Tumors. — Those are an invariable result of 
chronic inflammation of the ovary when that condition is not 
seen to promptly and managed properly. Irritation is the 
cause of those growths. This irritation may spend itself upon 
the serous membrane and give rise to dropsy of the ovary, or 
on the fibrous tissue, or upon the sebaceous glands, or other 
tissues of the ovary, thus giving rise to different kinds of 
effusions or tumors. Ovarian dropsy is the most common of 
cystic disease of the ovary. There are three forms met with : 
the simple cyst or bladder, filled with a fluid ; then there are 
the proliferous cysts, in which there are a number ; and the 

47 



546 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

dermoid cysts, the lining membrane of which is capable of 
secreting hair, nails, teeth, sebaceous matter, or any substance 
of the body. 

Causes. — It is unnecessary to recapitulate the causes, suffice 
it to say that they are to be embraced under all those of chronic 
inflammation of the womb and ovaries, acute and chronic — 
which see — and placed under one term, irritation. 

Symptoms. — Most cases, if carefully scrutinized, will exhibit 
well-marked symptoms of chronic inflammation of ovary — 
still the irritation seems to be even a little less, so the uneasiness 
or pain of that condition is often not well marked, and may, if 
the patient is of a cheerful, sanguine temperament, escape 
detection until the abdomen begins to enlarge. In other cases the 
pain in the ovary is well marked, and when the ovary fills up it 
gives rise not only to an appreciable tumor in the affected side, 
but gives rise to some irritation of bladder and rectum ; a sense 
of weight and oppression in the abdomen ; pain and numbness 
down the thigh of the affected side. Besides, there is the usual 
lassitude, weariness, backache, constipation, irritable bladder. 
Mensturation at first may be regular, but scanty or abundant. 

After tumor has attained some considerable size, the symp- 
toms become aggravated ; there is greaterpain and tenderness, 
as well as distension of the abdomen. Menstruation now is 
interfered with greatly, usually it is disordered, frequent or sup- 
pressed. There is loss of appetite, indigestion, constipation, 
loss of flesh ; frequent micturition ; urine scanty, often sup- 
pressed. Strength diminishes ; emaciation becomes greater ; 
hectic spells ; no sleep, sense of smothering, cannot go to bed, 
sits up. Meantime the abdomen increases in size, becomes 
enormously enlarged. The swelling is one-sided, it may lay 
over to the other side in the recumbent posture; the pain is 
only in front, if it is simple, but if it contains cancer germs the 
pain will radiate from the front to the back ; if it contains a 
fluid a sense of fluctuation can be detected even if the cysts are 
like a honey-comb, whereas if it contains any solid constituent 
of the body, hair, nails, bone, teeth, or cheezy matter, it is solid, 
dull on percussion. As the tumor grows it fills up the abdo- 
men and may cause dropsy of the abdomen by unravelling its 
peritoneal fibres ; oedema of the legs and thighs. As it pro- 
gresses patient's movements become impeded from the bulk of 
the tumor, suffering is augmented, all the spmptoms grow 
worse, the nights are wretched, the difficulty of breathing 
is very great; the swelling or dropsy becomes considerable, 
often suppression of urine and faeces; urseinic poisoning or 
fatal prostration is very apt to take place. 

Treatment. — When tumor is smaller than the two closed 
fists of the patient an effort at absorption is to be tried, which, 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 547 

with our new remedies, is often successful; and if it fails *it will 
be no barrier to ovariotomy. Every point must be well guarded 
and seen to, as the best of food ; regular evacuations ; good, 
comfortable sleep ; flannel clothing ; a perfect alleviation of 
all pain, and the best of hopes encouraged for a cure. Then 
selecting a tonic and alterative from the list for a week, then 
change, and so on for another week. Alteratives: ozonized 
Phytolacca compound, iodide of potass in compound syrup of 
stillingia, iodide of lime ; tonics : cinchona compound and 
mineral acids, sulphate quinine, glycerite of ozone or glycerite 
ofkephaline. In addition both pastiles and suppositories of 
iodide potass, belladonna, conium and iodide of lime. 

Locally, the ozonized clay over the entire tumor, bound on 
with a firm roller and T bandage. If the clay cause no redness, 
it can be put on fresh every morning, but if there is the least 
redness, it can be taken off and broke up. fine and water added 
to it and reapplied for four or five days. The action of this 
clay on this class of growths is most extraordinary — causes 
their thorough, positive dissolution and disintegration. As this 
processs goes on the bowels must be kept open with cascara 
and kidneys stimulated with cream of tartar lemonade. 

Cover entire tumor with the clay, and no more, and as this 
process goes on push diet, alteratives and tonics. 

All other methods of treatment are simply a loss of valuable 
time, such as tapping, aspirating. If theabsorption plan with 
the clay, and other drugs fail, then there is only one thing left 
and that is ovariotomy. In larger tumors than those men- 
tioned, the clay will reduce their bulk, and in some rare 
cases cause their disappearance ; but in very large ones we can- 
not speak with the same precision as we do of those of a smaller 
class. 

In ovariotomy, that is in making an abdominal section in 
the median line of the abdomen, ligating the pedicel of the 
tumor, then dividing it, removing tumor and returning the liga- 
ted stump into the abdomen, stitching up abdomen, etc., etc., 
and treating for peritonitis, do not wait too long, until there is 
no recuperative power left in the patient. 

(4.) Ovarian Displacement. — One on both ovaries are 
occasionally forced out of position by some uterine, or other 
tumor ; or an ovary may descend into the recto-uterine pouch 
of peritonaeum, or escape from pelvis, forming a true hernia of 
this gland. Displacements of the ovary by uterine tumors will 
present the symptoms due to that class of tumors ; suffering often 
ceases if tumor increase in size and pass out of the pelvic 
cavity ; the other class may be congenital, or may happen 
accidentally after purberty. In rare cases the ovaries have 
formed the contents of an inguinal, crural or umbilical hernia. 



HMHBHI 



548 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

(5.) Dropsy of Fallopian Tube. — Very rare. Fimbriated 
extremity of tube, together with uterine orifice, gets completely 
obliterated in consequence of chronic inflammation ; the por- 
tion of canal between the openings becoming the seat of an 
accumulation of pus or serous fluid. The cyst can be punctured 
or aspirated through the roof of vagina. 

LEUCORRHCEA. 

Under the head Chronic Vaginitis we spoke of leucorrhcea, 
but it will be seen that it is an essential symptom of all dis- 
eases of both vagina, uterus and ovaries. 

Causes. — So that the causes of leucorrhcea, irrespective of 
debility of he vaginal walls, are, acute and chronic inflamma- 
tion of the uterus, hysteria, cancer, displacements of all kinds, 
tumors, uterine catarrh, acute and chronic inflammation of 
ovary. 

Treatment. — So that leucorrhcea is often troublesome to get 
rid of, so long as the cause on which it depends exists. In all 
cases of leucorrhcea, whatever the cause may be, the discharge, 
whether it be mucous or muco-purulent, serous or bloody, or 
pure pus, is loaded with diseased germs, amoeba, bacteria, 
sarcinse, oidium albicans, yeast-germs, cancer, tuberculse, etc., 
hence the utility and efficiency of thoroughly syringing out 
the vagina thrice daily with antiseptic solutions, as borax in 
infusion of golden seal, solution of boroglyceride, chlorate or 
permanganate of potass, lime-water, tincture of iodine, and in 
all cases keeping patient upon tonics and good diet. Whatever 
the cause may be, remove it ; this facilitates a cure. Astringent 
washes are not of real merit as long as an organic disease 
exists. 

PELVIC HiEMATOCELE. 

An effusion of blood into peritoneal pouch, between uterus 
and rectum ; or, into sub-peritoneal tissue, behind and around 
the uterus. 

Causes. — Abortions, lingering labor, violence of some kind ; 
ovarian pregnancy, blows, kicks, falls. 

Symptoms. — These are very variable. If the loss is ex- 
cessive, there is the great nervous shock and exhaustion 
from profuse haemorrhage. Usually acute pain in the lower 
part of abdomen ; shivering, coldness of extremities ; vomiting ; 
increasing feebleness of circulation; ghastly appearance of face, 
and death in a short time. 

If the loss of blood is not excessive, there is nausea, rigors 
and a fever, with violent abdominal pain ; countenance very 
anxious, white and pinched. A frequent desire to empty blad- 
der, but inability to do so ; irritability of rectum ; in some 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 549 

cases the pelvic tumor may be felt through the vaginal walls. 
Danger of peritonitis, or of a recurrence of the haemorrhage. 
With great care absorption may be hoped for. In all cases 
there is the greatest danger to life. 

Treatment. — Perfect repose in recumbent posture Opium 
in large doses, to relieve pain and prevent faintness and col- 
lapse. Try sulphuric acid, turpentine, and alcohol , or alum 
and sulphuric acid. Bladders rilled with ice to lower part of 
abdomen. No getting up to micturate or defecate; draw water 
off. General principles to be observed. 

INFLAMMATION OF THE CELLULAR TISSUE OF 
THE PELVIS. 

Pelvic cellulitis is mostly met with in connection with some 
tubercular disease ; it may be a result of blows, falls, or other 
violence; abortions, tedious labor, or some uterine or other 
disease. 

Symptoms. — Local pain, throbbing, and tenderness, with 
painful swelling, usually appreciable at lower part of abdomen, 
or by vaginal examination. Simultaneously with the local 
pain, there is nausea and vomiting ; great constitutional dis- 
turbance; rigors, and a fever, with some pain in the head, back, 
and aching pains in the limbs ; difficult micturition and tenes- 
mus. If case progresses to suppuration, the above symptoms 
increase in severity, with additional rigors, throbbing, and ten- 
derness ; neuralgic pain down the thighs, and if within reach, 
fluctuation can be detected. Pus channels may form in dif- 
ferent directions, into bladder, vagina, rectum, colon, rarely 
into peritonaeum, generally finding their way externally. Na- 
ture is most provident of herself in these cases, by the forma- 
tion of those sinuses almost invariably reaching the surface. 

Treatment.— Those cases require great tact and good judg- 
ment ; the rectum and vagina should be injected daily with lin- 
seed-tea; hot poultices should be applied ; fever controlled with 
aconite, opium, or morphia, to relieve pain. Belladonna and 
opium suppositories every night at bed-time. Quinine and 
aromatic sulphuric acid, and carbolic acid and tincture of 
iodine internally ; the patient regularly sponged off. Most nu- 
tritious food, milk, raw eggs, beef- tea, juice of meat, and ani- 
mal food as soon as the stomach can bear it. If abscess point 
anywhere, it can be opened with advantage. As soon as the 
pus has been thoroughly evacuated, alteratives and tonics. 

The greatest possible care should be exercised during the 
stage of convalescence. Rest is an indispensable condition, to- 
gether with well-regulated secretions ; tonics, and the very best 
of blood-elaborating food. 



■■ 



550 DISEASES OF THE FEMALE ORGANS OF GENERATION. 



CHANGE OF LIFE. 

According to the last census, there were two millions of wo- 
men in the United States, between the ages of forty-five and 
fifty, undergoing the change of life ; and this number is an- 
nually kept up by fresh recruits ; so that we have, at all times, 
about that number. The importance of the period, the history 
of suffering endured, cannot be approximated; neither has its 
diseases been adequately investigated. 

The terms, change of life, turn of life, critical period, etc., are 
understood to mean a period of life beginning with those 
irregularities which precede the last appearance of the men- 
strual flow, and ending with the resettlement of health on a 
new basis. This is usually divided into a premonitory period, 
the actual stoppage or cessation of the flow, and the adapta- 
tion of the system to the change. The first indication of fail- 
ure of ovarian energy is irregularity ; when the failure is com- 
plete, perfect cessation. 

Although it is termed a critical period, it is not to be deemed 
fatal, if the patient's system is healthy. It is a gradual change, 
leading to better or worse; to complete recovery more fre- 
quently than to death. 

The streams of life, instead of flowing on in a smooth, 
tranquil current from the cradle to the grave, are marked by 
rapids, or milestones, which are critical, metamorphic, or de- 
veloping epochs. Seven, fourteen, twenty-one, are clearly and 
distinctly written on the first part of life ; forty -two, forty- 
nine, and sixty-three, are less deeply cut, but are distinctly 
visible in the later period of life. Those periods are charac- 
terized by important changes, which give a peculiar aspect to 
the physiognomy of the human body, and impart a family 
likeness to the diseases of epochs justly deemed critical, in 
which one or several organs of the body undergo changes. 
The object of each critical change in our bodies is to insure 
the greatest amount of health for each subsequent period of 
life. This object, if the vital forces are of average strength, is 
effected quickly ; but if there be debility or disease, then there 
is more or less disturbance, according to the degree or intensity 
of that state. The critical changes of dentition and puberty 
are frequently brought about without any disturbance or ill 
health ; nevertheless, they are often followed by debility. At 
critical periods, the activity of important apparatus may be 
too powerful, and disturb other organs, or too feeble to react 
on others. When the energy of the preponderance-seeking 
organ is above or below par, health may be impaired. With 
regard to the influence of critical periods of life, first and sec- 
ond dentition influences both sexes alike, and in the same 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 551 

way. Puberty is common to both ; but the impulse given to 
the constitution of man, by the perfect development of the 
sexual apparatus, is, in general, fully effective, and all-suffi- 
cient to insure its permanent activity until extreme old age ; 
whereas, in women the crisis is very liable to be delayed, or per- 
verted ; and even when puberty has been fully and effectively 
established, the health of woman is dependent on those oscil- 
lations of vital force, which render it most uncertain. The 
chemical activities of a woman cause her to mature earty ; the 
inertia of man's nature renders him slow, late in maturing. 
The same inherent qualities of sex give woman an early change ; 
whereas, man's change is delayed (if not too early precocious) 
till a good old age, he being capable of begetting children to 
seventy or eighty ; whereas, the moment a woman changes, fecun- 
dity ceases. It is true that children begot by very old men 
are of very feeble vitality. Although most women change at 
forty-five or forty-seven years of age, it does not follow that 
sexual appetite is extinct. Sexual congress may not be enjoyed 
by some, whereas others never have a warmth of feeling until 
the change of life takes place. The large proportion of women, 
on cessation taking place, become callous, indifferent, lose their 
sexual vivacity and vigor. 

Menstruation, healthy or morbid, marriage, pregnancy, par- 
turition, and lactation are critical eventualities in a woman's 
life, curing some complaints, giving greater activity to others ; 
and when, after having lasted thirty years, the action of the 
reproductive organs is being withdrawn from the system, then 
there arises a series of beautifully adapted critical movements, 
the object of which is to endow a healthy woman with a greater 
degree of strength than that which she had previously enjoyed. 
But this will not occur if there are disease-germs lurking in her 
system, such as cancer, tuberculaa, syphillis; then the seeds of 
those germs, when vital force is low, are liable to become active, 
and destructive ; because the very essential of the change, 
debility, brings them into active growth, and causes them to 
locate and grow in the very organs in which the change is pro- 
gressing. The change stimulates their growth ; imparts to them 
fresh activity. So, as a rule, it is at this period we meet with 
the greatest proportion of cases of cancer of the womb, and breast, 
adenoma, and other tumors. The change of life is only critical to 
the diseased. It is only them that need fear the crisis. To the 
healthy, to those who live according to natural laws, eat healthy 
food, avoid balls, tight lacing, bad literature, and sedentary 
occupations, nothing is to be feared. It is well to make no 
haphazard prediction, but if there is no disease, the process 
will not be critical. True, the disease may be got rid of; if so, 
it will mitigate the condition. The change does not cause dis- 



552 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

ease ; it detects it, brings it into active existence, and causes 
an aggravation of it. Thus, congestion of the womb, chronic 
inflammation of the ovary, etc., existing at the change, become 
excessive. Disease has little tendency to leave, or become in- 
active or quiescent during the change. 

The critical nature of a period is shown by its effects on 
the health in ensuing years. Thus, puberty is not only a 
crisis of most of the complaints of the preceding years, but it 
determines the health of the subsequent thirty-two years, for 
good or evil. In like manner, the change of life, if it can be 
consummated in a salutary manner, will influence the succeed- 
ing period ; nay, it will govern the whole subsequent period 
of life. So we can prognosticate, from the manner of the cri- 
sis, whether the after-life shall be good or bad. Five years 
after a woman ceases tells its own tale in the great additional 
strength of constitution. The greater sanative change, the 
greater longevity of woman after the period, her less liability 
to disease, and death, her very remarkable good health, and 
almost total immunity from the general run of ailments ren- 
der her last stage of existence a comfort and a blessing. 

From forty to fifty-five is a general period of invigoration 
for both sexes — a period in which the daily work of nutrition 
is very actively carried on in our bodies, rendering them 
stronger, more vital, healthier, and thereby insuring a more 
perfect performance of all the functions. The change in man 
is carried on insensibly and worked out without disturbance. 
In woman the passage is often full of danger, if natural laws 
have been violated, but the very great improvement that fol- 
lows the change is so salutary as to compensate for all the 
suffering. 

Although the phenomena of change of life are principally 
due to withering of the ovaries and suspension of their func- 
tion, it is aided by and associated with other structural changes, 
which take place in both sexes, due to coming age, such as the 
ossification of the cranial bones ; atrophy of spleen, and lym- 
phatics ; changes in bone, marrow ; degeneration of some form ; 
a smoothing clown of Peyer's patches in the bowels, and some 
shrinkage of the brain proper. But after cessation a woman's 
constitution is entirely remodelled ; she takes a new lease of life; 
decay and suffering has then less hold on her, and she begins 
anew. The importance of the change cannot be too highly 
rated, especially if easily passed ; for if it is accomplished with- 
out much disturbance, so will the future period be healthy ; but 
if gone through with great suffering, then we may expect the 
subsequent time to be one of long-continued misery. It is a 
final settlement for good or evil, and it may be reasonably enter- 
tained that if it does not excite the activity of some disease- 



DISEASES OF THE FEMALE ORGANS OF GENERATION. OOd 

germ in the body which previously existed there in a quiescent 
state, and the violence of the change be not excessive, it is 
reasonable to conclude from thousands of pre-existing cases, 
that the rest of life will be passed in uninterrupted good health, 
and unusual longevity attained. The invigoration of the 
health which follows is often accompanied with a great improve- 
ment in personal appearance — where the thin and emaciated 
become fat and comely, where the timid become bold and 
daring; while another class become masculine, and lose their 
feminine appearance ; their cheek bones project, the skin loses 
its velvety feel, creases show themselves, and stray hairs start 
on the upper lip or face. 

The effects of a suspension of ovarian action has a marked 
influence on all the emotions, desires, affections, passions, as well 
as on the brain proper, giving rise to debility, prostration, 
nervous irritability and confusion. 

Puberty and change of life are caused by physiological and 
anatomical changes in the same organs : puberty is ovarian 
evolution ; the change of life involution or stoppoge. The true 
seat of both is in the reproductive centre in the brain ; the one 
growth, the other death to that special centre ; the ovaries being 
merely the organs to perform the work. 

When, with proper age and perfect blood development, this 
co-ordinating reproductive centre in the brain matures (puberty) 
the seed or egg organs, the ovaries, increase in size, become very 
vascular, and begin to let fall ovula or eggs every twenty-eight 
days, and cause in modern civilized women menstruation. 
"When the reproductive centre in the brain dries up, which it 
usually does after thirty-two years of activity, the change has 
come ; the ovary or egg-bed, which, during the active period 
was smooth and turgid, becomes dried up, shrunken into a knot 
like a peach-stone, and it becomes difficult to trace the cavities 
of the Graafian vesicles, for their walls are pressed together. 
A few years later they shrink : wither still more ; become atro- 
phied, so much as to be no larger than a bean, and latterly 
completely obliterated, being marked by fibro-cellular tissue. 
This ovarian atrophy, or shrinkage, or wasting, or withering, 
comes from a want of germinal influence from the brain — there 
being no use for the organs, they wither an* die. This change 
is accompanied with corresponding changes in the fallopian 
tubes, determined by the same cause ; these tubes contract, 
wither, become impervious and perfectly obliterated. The same 
condition of non-use, want of stimulus, or enfeebling energy 
causes the womb to contract, become small, round like an 
orange ; its neck becomes thinner, and shorter, and obliterated, 
and in some cases an obliteration of its mouth takes place. 
The vagina becomes very narrow, short, and there is a shrivel- 



554 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

ing up of the pampiniform plexus of vessels which previously 
supplied the organs with blood, which accounts for the remarka- 
ble coldness of the parts. Incidental to this general collapse, 
the broad ligaments that retain the womb in its position also 
shrink and disappear. The breasts, which are a part of the 
reproductive s}^stem, also become cold, small, and wasted. 
During the change they are often seriously affected, being 
painful and congested, if not otherwise diseased. It would be 
a matter of infinite surprise how so many phenomena of health 
and symptoms of disease could be determined by two little 
bodies whose structure does not appear complicated, but the 
fact is unquestionable that not the bodies, but the brain, is the 
source or seat of change. The ovaries are energized by that 
nervous centre of sexual power located in the spinal cord, op- 
posite the fourth lumbar vertebrae, and supplied from the 
cerebral centre ; but although a central act in the brain through 
the cord, there can be no perfect exercise of sexual power with- 
out well formed and healthy ovaries. The ovaries influence 
all parts of the body (directly the cord and brain) through the 
medium of their nerves, for as they have both ganglionic and 
cerebro-spinal nerves, they can react on both the ganglionic 
nerves and their centres, and the cerebro-spinal and their 
central organs. 

Whether the ganglionic be an independent system of nerves, 
or an offshoot of the cerebro-spinal nervous system, it is not 
necessary here to discuss. All are agreed that vaso-motar 
nerves follow every capillary to their minutest ramification 
and govern the nutrition of every part of the body. All organs 
of nutritive life are supplied with ganglia and a plexus of 
ganglionic nerves ; but they all communicate together, and 
with a larger plexus and more voluminous ganglia, situated in 
the viscera of the abdomen. And before those foci of nervous 
matter were discovered, this region, that is the ganglia on the 
bowels, liver, spleen, bladder, kidney and reproductive organs, 
was called the lever of forces by which the body is moved. 
Sensation and motion are dependent on the cerebro-spinal 
nerves, nutrition on the ganglionic ; but there is a concentration 
of ganglionic nervous power in the central ganglia which 
gives and receives from each viscus a variable impetus. The 
ganglionic is a centre of nerve force, capable of controlling 
and disturbing the various parts of the body by its nervous 
fluid or soul. 

The human body is so constructed that the various compo- 
nent organs act upon each other in the way most conducive to 
health, until the age of puberty. At that time health may 
fail and the whole system languish, unless the reproductive 
organs come into full activity. From puberty to the change 



DISEASES OF THE FEMALE ORGANS OF GENERATION. OOO 

of life, the health of woman cannot be maintained without an 
energizing influence from the reproductive centre in brain and 
cord, so as to impart an appropriate amount of ovarian influ- 
ence. If the ovarian energy reacts under proper nerve 
stimulus in a healthy way, it will augment, vitalize, energize 
the visceral centre, or brain, and cause the function of nutrition 
to be performed with increased energy ; give vigor, instinctive 
consciousness of strength. If the ovarian energy be inefficient, 
the abdominal brain, the visceral centre of ganglionic action, 
is half or partially paralyzed, and uneasy sensations are felt at 
the pit of the stomach, a feeling of sinking, of faintness, gone- 
ness, or even actual fainting is sometimes induced; defective 
nutrition follows, with anaemia of the cord and brain, vulgarly 
termed hysteria, met with at puberty, during pregnancy, lacta- 
tion and change of life. If the brain does not furnish the 
necessary amount of ovarian stimulus, so that evolution is in- 
efficient, the menses will come on in an irregular way, off and 
on and likely scanty ; if it be too strong, as under emotion, pas- 
sion, it will react upon the adjacent viscera and cause violent 
disturbance. 

All the organs in the chest and abdomen are, on their front 
part, covered over with the cervical sympathetic, similarly 
endowed with ganglia or little brains. They are knit together 
by a mysterious net- work of nerves ; they sympathize with each 
other at puberty, menstrual period and change of life, and in 
this way any disturbance of the ovaries, irrespective of reflex 
states, will give rise to nausea, sickness, depraved appetite and 
deranged bowels and kidneys. If the ovarian stimulus be too 
great for the allied abdominal organs, there may be pain in 
the ovaries themselves ; pain, disturbing sensations, irritation 
which may be transmitted to a weakened cord and bulb, then 
hysteria, tetanus, nervous irritability, restlessness, hysterical con- 
vulsions, or there may be a numbness in skin and other parts. 

The strength or relative weakness of the nervous system may 
be inferred from the condition of anaemia of brain and cord 
that is present. The solar ganglia in both sexes form an im- 
portant centre of nerve force. Insufficient ovarian influence 
having reached the solar plexus affects the brain chiefly by 
means of the pneumogastric nerve, so any disturbing influence 
at purberty, pregnancy, parturition, change of life, may be 
shown by the distressing headaches, fretfulness peevishness, 
irritability, capriciousness, perversion of the moral nature, 
moral insanity. In other cases, excessive or disturbed ovarian 
action is manifest by high spirits, or depression, a cloud or a 
weight on the mental faculties, haziness of mind, brain mud- 
dled, memory faithless and an unquenchable desire to sleep 



556 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

during the day, remaining awake all night, almost amounting 
to coma or lethargy. 

From puberty to the change, healthy women, when not 
pregnant or nursing, drop ovules every twenty-eight days, and 
as a rule modern civilized women lose about four ounces of 
blood. But there are women in perfect health, who live ac- 
cording to nature's laws, eat healthy food, avoid modern litera- 
ture as a destructive ovarian poison, that have perfect ovula- 
tion, are easily impregnated, and whose womb does not bleed 
on the shedding of the egg in the ovary and dropping within 
its cavity. Those women enjoy the highest possible standard 
of health. Indian Women, in their aboriginal state, seldom 
lose blood at the monthly period, nothing but a white, glairy 
discharge. 

Sexual involution has an ill-defined beginning and end, and 
only one fixed date, cessation. The activity of the menstrual 
period is usually thirty-two years, between fourteen and forty- 
six ; but there are cases, once in a while met with, where the 
menses stop as early as twenty-one, twenty-eight, thirty-five, 
and at all periods up to sixty-one. The average, however, is 
forty-six in healthy women, and more cease to menstruate at 
forty-five than any other period in life. It depends greatly on 
accidental conditions of life. Blows on the head or back, frights, 
and other nervous states may prevent its appearance, and ar- 
rest it at any time, either when the discharge is on or off, 
and, if the shock is grave, forever. Its continuance depends 
greatly on the state of the health, the richness and purity of 
the blood, the freedom from worry, struggle, shocks, jars, and 
uterine and nervous disease ; but taking all these into account, 
the average among our ladies is forty -six. Races, being essen- 
tially distinct, have each their peculiarities in menstruation. 
It is said the Hindoo women run from twelve to sixty, when 
free from disease ; and the Laplanders and other races have 
different peculiarities and eccentricities. 

Ovulation and menstruation stand together, very nearly as 
cause and effect. Periodicity is an element in a woman's nature. 
Vaginal blood, even if it occurs with periodicity, when late 
in life, may not be menstrual, but may come from conges- 
tion, ulceration at the neck, polypi, and other morbid states. 
Still there are, as we know, rare cases of cessation at sixty-two 
or later, in strong constitutions, so it is well to be guarded. 
Cases at sixty and seventy menstruating are mostly due to 
some disease. Out of one-half million women who become 
mothers from under twenty to above fifty, seven thousand bore 
children from forty-five to fifty years of age, and one hundred 
and sixty-seven were mothers after they passed their fiftieth 
year. Cases of menstruation admit of great variation. Iso- 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 557 

lated cases are met with at six ; more numerous at eight to 
eleven. Still there are a greater number late, from eighteen 
to twenty-two ; while the general average does not vary from 
fourteen to forty-six. 

The Irish, at home in their salubrious' atmosphere, with a 
fish diet, are remarkable for their fecundity. Their nervous 
systems and their ovaries are endowed with wonderful activity. 
The fish-eating and oat-meal-consuming races, as the Scotch, 
Swedes, Danes, Canadians, have strong procreative powers, 
and reproduce themselves speedily. 

Ovarian activity, then, is commensurate with constitutional 
vigor. An unusual prolongation of ovarian life and longevity 
indicates a healthy condition of the functions of vegetative 
life, and when prolonged, it implies great vigor, strength, and 
endurance, and means a good old age. 

During the wear and tear, struggles, hopes, cares, sorrows, 
vicissitudes of life, the ovaries are often simply paralyzed, and 
their action suspended ; when the difficulty is removed their 
function will be resumed. Visceral disease has the same effect ; 
when the disease is cured, and better health brought about, 
their activity is restored. There may be a stoppage for a long 
time, and then a recurrence. 

A woman past the age of fifty-three may be regarded beyond 
the age of child-bearing, except in very rare and exceptional 
cases.. Pregnancy late in life is often mistaken for other dis- 
eases; and late labor is dangerous to the mother; indeed, it 
may be regarded as an extraordinary risk. 

Cessation is often delayed by morbid blood and affections of 
the womb and nerves, ulceration of the os. We will again 
repeat that there may be uterine bleeding without menstrua- 
tion. It should not be called menstrual unless it occurs be- 
tween fourteen and forty-six ; comes periodically, or with peri- 
odical paroxysms, and the blood has the characteristics sub- 
sequently described. On the approach of a fever, or pneumonia, 
or intense worry, or excitement, the womb of an elderly lady 
may bleed. 

Early cessation is very common, and consists in a premature 
paralysis of the ovaries; and this extinguishment of the re- 
productive force may be caused by hard work, worry, miscar- 
riage, or induced abortions, falls on back, cold, fright, wet, 
purging, cholera, fever, long trouble, drugs, occupations — all 
paralyzing influences. It is called early any time before forty- 
six, whether it be at twenty-one, twenty-eight, thirty-five, or 
forty-two. This condition runs in families; mothers and 
daughters resemble each other in this special department only. 
Women of the same family usually begin to menstruate at the 
same date; have the same kind of trouble, same eccentricities, 



558 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

same complications; cease at the same time, with the same 
peculiarities; and even die under the same conditions. In 
this alone they resemble the mother ; in their mental charac- 
teristics and conformation, they are specially the same as the 
father. 

Prostitution has a fearfully deteriorating influence on both 
brain and ovaries, and causes a loss of reproductive power. The 
vagina of a woman whose sexual act is loose and varied is cold ; 
it has lost its vital vigor and contractility ; it has no vivify- 
ing influence on the male. Its mucous membrane is purple or 
livid ; it has none of the cherry redness of the virgin, and it is 
even in a more dilapidated condition than that of the woman 
after the change. As a consequence, if they live over the three 
years allotted to their abnormal existence, they change, irrespec- 
tive of age. Even the conditions of life have a modifying in- 
fluence on menstruation and change ; the former comes on late 
in the poor and ceases early, whereas in the rich, it is early and 
holds on longer. 

Menstruation usually takes place about the period of full 
moon in about two-thirds of all cases; the other one-third, in the 
middle of the month. In spite of this disparity, there can be 
no doubt but that ovulation is regular, inevitable, uninter- 
rupted ; but the menstrual function shifts, owing to some special 
attribute of the nervous system, and this fact shows that it is 
governed by nervous influence, and explains how strong emo- 
tion may repel or alter the time of its appearance. 

Menstruation is the effect of ovarian action, the shedding of 
an ovule ; but the menstrual flow, or a discharge of blood can 
occur without ovulation, just as ovulation may occur without 
menstruation. Nervous emotion, over-exertion, reading sexu- 
ally exciting literature, passion, hearing disagreeable news, 
fatigue, quarrel, and jars will bring on menstruation in some 
ladies without an ovule being shed. That sudden passion should 
cause the uterine surface to perspire blood is a well-known 
effect. 

The average duration of the menstrual function is thirty-two 
years, which is the possible duration of female fecundity, and 
that of each successive generation. The mode of stoppage in 
the largest percentage of women is by a gradual diminution of 
the flow ; by a sudden stoppage of the usual flow, or by a flood- 
ing or successive floodings, or by alternate copious or scanty 
flow, or at irregular intervals longer or shorter than twenty- 
one days. The greatest number exhibit a diminution, a gradual 
decrease in quantity, and also in the time of its duration ; the 
other class, where it is erratic and the duration irregular ; the 
next class, where there is flooding, the flow growing less and 
less, and at long intervals apart, till it becomes a mere show. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 559 

The discbarge, at first like blood, becomes blacker and blacker, 
clotty, then like cinder-dust or dirty-green water; in other 
cases like a lochial discharge, in smell. The menses, in health, 
are not to be regarded as pure blood, there are certain chemi- 
cal elements in them induced by the brain, ovarian act, the 
presence of the ovule, that renders this blood totally different 
from the blood circulating through the lady's body ; so much so 
if it is absorbed, owing to sudden suppression, it will not mix, 
but is thrown off at some weak point in the skin, lungs, nose, 
bowels ; it is sweet, not saltish like pure blood, but prior to and 
during the change it is still further altered in quality, whether 
it be scanty or profuse, at first paler in color, or later, brown or 
simpty green water. As a rule ovarian influence begins to fail 
before menstruation becomes irregular, because when the sexual 
organs are healthy their loss of power is gradual, the ovarian 
forces become feebler and feebler until they can no longer 
determine any influence over the uterus and the discharge 
subsides. 

The Period Before and After Stoppage. — The date of 
the last regular menstruation is to be taken, and the time calcu- 
lated during which the flow became irregular, scanty, and the 
health unsettled. The length of the premonitory stage of 
irregularity, off and on, varies from a few months to six or 
seven years; the average time being two years and a half 
before, and two years and a half after. This divides it into two 
periods of pretty nearly equal length ; the period before, with 
its varied symptoms, is followed by a period after, in which 
every twenty-eight days there are sensations of a peculiar kind, 
which continue along growing less and less. These monthly 
occurrences are very varied, embracing lumbar and abdominal 
pain, leucorrhoea, headache, diarrhoea, bleeding piles, hysteria, 
asthma, debility, sweats, dyspepsia, stomatitis, swollen gums, 
legs ; usually lasting four or five days. 

When all is over, the perfect recovery of health, and its re- 
settlement on a new plan takes two or three years, after which 
women are not liable to debility, floodings, sweats, heats, and 
other unpleasant symptoms of the change. 

Diseases, with which a woman may be accidentally affected 
at the change, may bar the progress of involution, and protract 
it indefinitely. Fibroid infiltrations in the uterus have been 
known to delay the change for many years. The ovaries may 
be shrivelled and shrunk ; reduced to an amorphous mass of 
fibrous tissue, while the womb is still large, and bleeds promptly 
every twenty-eight days. These events are of vital importance, 
especially when disease-germs have been lurking in the system 
for years, as it brings them into active existence. 

The great quicksands and precipices which a woman should 



560 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

avoid during ovarian activity are sexual excesses ; the use of 
drugs ; abortions, or miscarriages ; and our modern demoraliz- 
ing literature ; these, if indulged in, shipwreck her existence 
at the change. 

The removal of the ovaries during the thirty-two years of 
activity, induces an artificial, but genuine change. This pro- 
ceeding is sometimes necessary ; this castration of the ovaries 
is performed when menstruation causes very serious and grave 
disturbance of the nervous system, as mania, epilepsy, or when 
they are affected by disease, as interstitial fibroid infiltrations, 
or tumors, that give rise to flooding, or other very fatal con- 
dition. Castration is a grave proceeding ; dangerous to life, by 
inducing peritonitis, and forever, renders sterile the woman, and 
never sould be done without the consent of the patient and her 
friends, and after consultation with several other physicians. 

The question is frequently asked, "Is fecundity possible dur- 
ing the change of life? " Yes, if there are properly matured eggs 
evolved ; but after the forty-sixth year the chances of fecundity 
diminishes, becoming less and less every year ; but it is possible 
just so long as eggs mature and the menstrual flow appears, 
however irregular the latter may be ; cases have occured under 
my own observation. 

Is fecundity possible after cessation ? Most assuredly no. If 
the ovaries have ceassed to evolve eggs, if they are withered 
and wasted, shrivelled up and inert, the woman is as barren as 
a stone. We have already stated that ovulation is not indis- 
pensible to menstruatton ; that with very high vital force, 
ladies may pass eggs or shed ovules without discharging 
blood, and become pregnant without ever having the menses. 
Healthy women never menstruate either during pregnancy or 
nursing, but there are many now-a-days who do. Conception 
has taken place before menstruation, so it is only possible when 
the ovaries and brain are healthy, and when ovules are 
thrown off, irrespective of the numerous eccentricities of the 
generative function. 

There is a perfect remodelling of the system at the change of 
of life. For thirty-two years, every twenty-eight days it has 
been habitual for a healthy, unmarried woman to lose an 
ovum, and with it four ounces of blood, so that when the great 
crisis in life, the change, comes, there will be numerous efforts 
on the part of nature to get up various contrivances, compen- 
sating discharges and drains, which act as waste-gates, until 
health is restored or permanently re-established on a new basis. 
Those compensating agencies are varied and numerous, and 
embrace the various natural outlets, as the skin, lungs, urine, 
stool haemorrhages, and obesity. 

Women, at and after the change, exhale a much larger 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 561 

quantity of carbon than before ; their urine is loaded with 
brain waste in the form of phosphates and chlorides, which in- 
dicates a great revolution in the nerve centres; the lithates 
are abundant also, which shows that nitrogenized elements 
are undergoing chemical change. The secretion from the skin 
is very great; there is great heat, intense radiation, exhala- 
tion, evaporation, dry flushes; so much so that the caloric of 
the elements of chemical change bursts in flushes from the 
face, neck, chest and other parts of the body. The pulse is not 
accelerated, nevertheless the generation of heat is indescribable ; 
the patient requiring little clothing, and during the intense cold 
of winter will have doors and windows open. Those heats are 
independent of another class, namely the heats and colds of 
nervous depression. The heats or flushes of the change are like 
hot waves, frequently wafted from the surface of the body 
eight or more times per hour, decreasing after the change has 
taken place, and disappearing in two or three years. It is rare 
for them to continue long, unless the patient is s abject to worry 
or some form of nervous irritation. The face, neck, breast, 
hands, feet, nails, feel like fire. Florid, sanguine women have 
a greater power of generating heat than the thin and nervous ; 
in the sanguine temperament there is greater buoyancy, more 
hopefulness ; molecular change is greater than in the dark or 
bilious; there is less resistance to change; consequently the 
heat generated is greater, and they suffer terribly from a 
variety of conditions that a black haired and eyed woman is 
almost exempt from. Sweats, copious and persistent are also 
present. Vicarious discharges are very common if there be 
weakened patches anywhere, as bloody discharges from the 
nose, mouth lungs, skin, etc., if these parts are feeble, 

The effect of the change on all women is to cause a perfect 
remodelling of their physical and mental traits : the lean be- 
come stout ; they experience a great improvement in health. 
The robust or fat do not fight the battle of the change so well ; 
they cannot convert their superabundant blood to other uses 
rapid enough ; they drag along very slowly ; are more liable 
to haemorrhages. The breasts in all atrophy, but if the woman 
gains flesh or gets stout, they usually become quite heavily 
loaded with fat and become pendulous. Once the change is 
consummated there is often a grand remodelling of the intellec- 
tual faculties, and it is satisfactory to know that the highest 
grade of intellectural culture, the most profound studies, can 
now do no harm ; so it is at this period of life only that woman 
should engage in literary and scientific pursuits. 

Change of Life, Its Cause and Treatment. — Before con- 
sidering this subject in a practical light, it is necessary to have 
a proper knowledge of the generative organs of woman ; they 

48 



562 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

must be looked at in an anatomical, physiological and patho- 
logical condition as the great motive power, the potential lever 
of the world. It is the nervous system of the female repro- 
ductive organs that specially solicits our attention, as it is 
there, in its deep abyss, in its incomprehensible structure of 
animated tissue, that the ovum or egg is evolved, before any 
microscope can detect its organization. 

In another part of this work, we divided the nervous system 
into three parts, although essentially one, a unit — the brain 
proper ; the cerebellum and spinal cord, with the reflex 
centre, the medulla oblongata; and the great sympathetc or 
ganglionic nerve centre in the chest and abdomen ; those three 
points, essentially one, work for each other.; any damage done to 
the one injures the other two. The three persons in this trinity 
are co-equal, but as the uterus, ovaries, etc., are covered on their 
front part with the sympathetic or ganglionic nerves, we speak 
of it more frequently, and as it is the potent instrument of life, 
a wondrous power, the citadel of the soul, we may have to recur 
to it again and again. 

Definition. — Change of life may be defined to be that state 
in which the brain and cord fail to impart the necessary 
stimulus to the ovary, so as to enable it to secrete ova. It is a 
change, a crisis, a critical period, a failure to elaborate ova, and 
cessation of the menses. 

Causes. — Although there is but one cause — a failure of the 
ovaries to shed ovules — still to be more explicit, we will arrange 
the causes into exciting and real. It is to be understood that 
it is just as natural for a healthy women to shed ovules every 
twenty-eight days for thirty-two years, as for a tree to bear 
fruit. The exciting causes that bring about a sudden or 
early change may be any disturbance of the abdominal 
brain, as violent emotions, intense or unhealthy desires, grovel- 
ling affections, degrading passions ; hence, fright, grief, worry, 
struggle, emotional or sensational reading,; masturbation, pro- 
miscuous sexual intercourse, predispose to a change. Delete- 
rious trades, or occupations, in drug or chemical laboratories 
are productive of ovarian change. The use of such drugs as 
bromide of potass, belladonna, ergot, opium chloral, mercury, 
iodide potass, all acro-narcotics, will in time produce effects an- 
alogous to castration — dr}^, wither, choke the springs of life. 
Blows on the head or back, poor or diseased blood, disease- 
germs of typhoid, of syphilis, cancer, tubercular, etc., are excit- 
ing causes. 

The true exciting cause is when the brain and cord fail to 
send the stimulus to the ovaries, and as a result they are sterile, 
barren; then, as there is no further use for the organs, they 
shrivell up, waste, and disappear. The uterus also becomes 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 563 

inert, its normal waves are gone, even the source of their nutri- 
tion, their special plexus of vessels, not being needed, wither 
and become obliterated. 

Symptoms. — In enumerating the symptoms, it is not our 
purpose to describe the changes that take place in the skin and 
bones, the vertical wrinkles and hair on the lip, or stray hairs; 
nor the atrophy of the ovaries ; the changes in the womb, the 
obliteration of its neck and vessels ; nor other changes. What 
we are desirous of doing more especially is to describe a train 
of symptoms, several of which are present in every case, and 
imperatively demand medical assistance. We shall begin 
with those of most frequent occurrence. We have already 
stated that there are at all times two millions of women be- 
tween forty-five and fifty years of age, in the United States, 
undergoing the change of life. Now, it is fair to presume 
that one-half have lived in a natural way, in conformity to 
natural laws, and pass over the change so easily as to seldom 
require any medical aid. The other half are those that suffer 
from one or more of the following symptoms : 

Nervous Debility, with great languor and lassitude, is present 
in every case to a greater or less degree. It begins with the 
first indication of change, grows worse and worse till final ces- 
sation ; when that takes place it grows less and less till health 
is re-established. This is an essential symptom of the critical 
period, and usually begins to affect most women about forty. 
Some of the phases of nervous debility may be due to the ordi- 
nary wear and tear of life, and are common to both sexes; but 
at or about the change they form a special group by themselves, 
occurring with greater or less aggravation in different ladies, 
variable in each individual, never two alike, and most marked 
about three years before the complete stoppage, and continuing 
three years after the change has been completed and a new 
basis of life established. 

Nervous depression, debility, weakness, or some form of nerve 
tire or trouble, is present in all cases. It is a marked charac- 
teristic symptom either in the brain, cerebro-spinal system, or 
ganglionic. The nerve prostration never slackens its pace, but 
persists till the change is accomplished, simply modified by 
location of weakness. It is a perfect revolution ; when the 
stoppage or dropping of eggs cease every organ supplied with 
the sympathetic is affected ; the spleen, kidneys, liver, larynx, 
face, bowels, womb. The three brains have worked harmoni- 
ously for thirty-two years, and now there is a disturbance. 
This disturbing influence generally shows itself in a diminu- 
tion of the flow ; in a weariness, a torpor, a lethargy, head- 
aches, and an indescribable feeling of goneness; the brain and 
cord fail to give an adequate stimulus to the ovaries, and 



564 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

energy is impaired ; the ovarian loss itself gives rise to mild or 
severe nervous disturbance. If there be disease of the sexual 
organs the symptoms of ovarian disturbance will be more severe, 
and prolonged beyond their natural termination. If there be 
something in the nervous system eccentric, the reaction on the 
ovaries may be analogous to shock or paralysis. 

We cannot be surprised at the immense train of nervous 
symptoms so common at the change, when we reflect on the 
great volume of brain concerned in the evolution of the eggs, 
and its complicated and artistic structure, rich in gray or intel- 
lectual matter; and when we turn to the visceral brain, — the 
ganglionic nervous system, — that incomprehensible seat of life, 
of vital force, of good and evil, located, centralized, and con- 
gregated into little lumps of nervous matter, bound together 
by tangled skeins of nerves, reflected over the viscera, not only 
the seat of power, but guides nutrition, healthy and morbid, 
and controlls the action of blood-vessels, heart, and lungs. 

The third brain, the ganglionic system, and great sympa- 
thetic, is an offshoot from the cerebro-spinal at the junction of 
the last cervical with the first dorsal. The ganglia are scattered 
everywhere over the viscera, uterus, ovaries, and contain every 
kind of nerve matter, but are extremely rich in gray or sentient 
cells. These ganglia must be considered as little brains, each 
having its own range of power ; being very sensitive, through 
them the brain becomes cognizant of ganglionic impressions. 
The ganglia serve for a storage of power, of vital force — a source 
of energy for the sympathetic ; the fountain from which gangli- 
onic nerves draw their supply ; by the currents of which the 
capillaries and nutrition is maintained. 

The centralization of vital force in the solar plexus and sym- 
pathetic renders the abdominal brain of immense importance 
at the change of life. To show its intrinsic value and its intensi- 
fication of power, a blow on the stomach will cause instant 
death, and yet leave no lesion or mark to explain the cause, not a 
trace. The ganglionic nervous system furnishes to the human 
frame a nervous influence, a reservoir of nerve-force, giving to 
the cerebro-spinal a power of which the human mind only 
recognizes the force when it fails. In the reproductive organs 
of women, a prominent symptom, even in health, is occasional 
nerve prostration at menstruation, or after connexion, parturi- 
tion, or nursing ; many women feel a great loss of energy. 
Woman cannot pass through any stage that communicates life 
without a momentary loss of a portion of her own vital energy. 
She reminds us of those animals that die when they have 
transmitted life to others. Nervous debility is so constant, and 
so intense in all women at the change, as to be fairly considered 
the primary symptom ; and it is justly so ; and her complicated 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 565 

mechanism readily explains it. Her nerve exhaustion fairly 
causes her to lose her equilibrium, and some special nervous 
disease is likely to supervene. 

Flushes of Heat are present in about eighty cases out of one 
hundred, and slight heats and colds in the balance. This symp- 
tom is present to some extent in all cases of nervous depression, 
but the intense heat prior to, during, and subsequent to change, 
must be explained by the great chemical change going on in 
the body. The heat is due to molecular action; and the 
intensity of the heat, as well as its quality, is due to the patho- 
logical conditions present, so that women at the change gene- 
rate more caloric, because there is more change going on. In 
most cases it is a dry heat, a dry exhalation. If perspiration 
be present, it is likely cold or clammy. It is to be regarded as 
a salutary effort at elimination. It usually has an irregular 
area of distribution, as flushes of the face, breast, body, hands, 
and feet, and if not diverted off by the safety-valve, the skin, 
may manifest itself internally in a burning in some organ. As 
a general rule, the heat starts from the solar plexus in abdo- 
men, then the chest, and face ; the parts are suffused, hot, like 
a burning stream. They are not preceded with a chill unless 
there is great nerve-shock. The flushes occupy from a minute 
to a quarter of an hour or longer in duration, and are repeated 
six or eight times an hour; usually begin three years before, 
and continue three years after cessation ; face and neck are most 
obnoxious to them, but they affect any part of the body, even 
the nails, which often feel like fire. Stout or plethoric women 
suffer most intensely in their severity as well as long duration. 
These heats never affect the pulse, which is usually slowed. 
These heats must never be confounded with blushing, which is 
an act of the sympathetic ; our women still blush, even at sixty, 
seventy, and upwards ; and blushing will arouse them afresh. 
In blushing heat is also evolved by the shock or emotion of the 
sympathetic. What this nerve does under emotion, it does also, 
to a certain extent, on the subsidence of ovarian stimulus, and 
aids, to an infinitesimal degree, in the production of heat. The 
heat flushes of the change are like tornadoes of heat, heated 
waves, which cause patient to discard some of her clothing and 
keep windows and doors open. 

Perspirations are the next symptom in the frequency of its 
occurrence. It may follow the heats, if nerve debility is very 
great, but it very frequently exists by itself. It is often very 
great, amounting to twenty or thirty ounces in the twenty-four 
hours, independent of the insensible perspiration, which is in- 
creased. The skin is the most easily moved of all the safety- 
valves of the body, and is much influenced at the change of life. 
It is of great service in drawing off waste and solid elements not 



566 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

needed, and its active function is desirable. The critical nature 
of the sweats at this period is of much importance ; they are 
often heavy, saturating body-linen and bed-clothes. As a gene- 
ral rule, these perspirations do not come from the entire body, 
but are generally restricted to portions, as the brows, face, breast, 
hands, feet, and pit of stomach. Like the heats, they begin 
early and continue on to cessation, and subsequently diminish 
in intensity and duration, and gradually disappear. 

Leucorrhoea, or the Whites. — Next in frequency, we find this 
discharge from the vagina, beginning two or three years before 
cessation, and continuing the same length of time after. It 
may occur all the time, or at irregular intervals, or periodic 
monthly. They are so common at the monthly period at this 
time that they may be considered as its legacy ; especially so, 
when they come periodically. The critical nature of such dis- 
charges shows that they should not be stopped, although it may 
be proper to restrain them. When it occurs periodically, it 
usually continues several years after cessation. 

Hemorrhage occurs in about sixty cases out of every one 
hundred; two-thirds of all cases from the uterus; the other 
third from nose, mouth, lungs, nipple, kidneys, rectum, pubes ; 
skin, in blotches or excoriations. They are all critical, and are 
to be regarded as the harbingers of serious trouble. Flooding 
at the change, in some cases, prevents complications, and relieves 
nature, and affords time for the readjustment of the system to 
the new order of things. Successive floodings are very common 
in the robust ; but may occur in any temperament as olten as 
there is an overload of blood. The sanguine, with the florid 
features, are specially prone to it ; blondes more obnoxious to 
it than the dark. A continual dribbling from the womb, at 
the change, is very undermining to the strength. It does not 
weaken down so much as when occurring at the regular periods. 
The best mode of stoppage is one gradual and progressive. 
Flooding is not always to be laid down to premonitory or ex- 
isting cancer without the pain in front and back opposite, nor 
to ulceration of neck or womb. The whole net-work of uterine 
nerves are confused, upset, and a fright, emotion, passion, excite- 
ment, bad news, a fit of sneezing, a connexion, may bring on 
a flooding. When floodings occur a few months after cessation, 
it is dangerous, because the system cannot repair itself fast, 
and the patient becomes much weakened thereby. 

Next in the order of frequency of occurrence of symptoms 
are Headaches. We have no words to describe the dreadful 
headaches of the change of life. It is a frequent, and often a 
ruling symptom. The pain, and its location, is very variable; 
sometimes a dull, heavy pain, with drowsiness; at other times 
it is frontal, sharp, excruciating; in other cases it is in the 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 567 

temple, or top of the head, or at the occiput ; most frequently 
behind. The nature of the pain may be described as shooting, 
throbbing, gnawing, boring, or like a nail driven in, or as if 
the head was in a vice. It varies in intensity from a mere in- 
convenience, to the most agonizing ; sufficient to prostrate the 
most vigorous. It is often accompanied with nausea, or sick- 
ness in the stomach ; in some cases there is vomiting. It is 
purely nervous, and is present in both plethoric and anaemic. 
It may be associated with pains elsewhere. It is usually off 
and on, or periodic ; and in some cases it is a true neuralgia of 
the brain, exists with flushes, perspirations, haemorrhages, etc. 

Next in succession comes Drowsiness, Giddiness, like being tipsy, 
so that when she walks she likes to have something to hold by, 
or feels like a top. The drowsiness is peculiar ; sleeps all night 
unrefreshed, and falls asleep during the day ; sometimes feels 
stunned and lost for an hour, with hot pain at pit of stomach. 
Before the change she was all life and animation ; clever, 
sprightly ; but now, stupid ; let things fall out of her hands, 
and fall down in attempting to pick them up. Such a condition 
is often present at puberty, and is often bad when the flow is 
scanty, painful, or absent. The tendency to sleep is great, and 
often accompanied with an uneasy sensation of weight in the 
head, a feeling as if there was a cloud or cob-web on the brain 
that required removal; loss of memory, power of exertion; 
heaviness of head ; dullness of intellect. This drowsiness, stupor, 
is often a precursor of insanity. Mental stupor is often present 
during pregnancy, but passes off. 

Catalepsy, Melancholia, Nervous Stupor are due to, and caused 
by a morbid action of the ganglionic system on the brain, 
brought about by the disturbed performance of the reproduc- 
tive organs. It is a kind of spontaneous narcotism. 

Hysterical Symptoms are quite common; but they are always 
associated with nervous debility, flushes of heat, sweats, ab- 
dominal pain, piles, or haemorrhages, such as a gush of blood 
from mouth or nose. 

Epilepsy is very common at puberty ; disappears when the 
menses are established, and is very liable to reappear at the 
change. Very frequently the attacks are periodic, corresponding 
to the flow ; usually go away when the change is well over. m 
Minor symptoms of epilepsy are very common, as vertigo, 
sensations, or aurae, temporary loss of speech and conscious- 
ness, twitching of the facial muscles. 

Aphonia, or loss of voice at puberty, is very likely to recur 
at change, and then disappear finally ; so with stammering or 
stuttering, fear or dread. 

Chorea is very rare at change. 

Insanity, from the best statistics, is more frequent among 



568 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

women from twenty to forty, while the reproductive organs are 
endowed with their greatest activity, than between forty and 
sixty. This latter time, when hope is fading, and physical 
strength giving out, is the period when men die insane, and 
when women are most exempt. From sixty to eighty, when 
the sexes most resemble each other, insanity affects them 
equally. The change of life is not prone to insanity ; the 
puerperal state and nursing more frequently give rise to it, 
which explains the reason of its prevalence between twenty 
and forty. 

Delirium, Mania, at puberty, ma}^ be expected at change. 

The two mental states known as Melancholia and Hypochondriasis 
are very common at the change, particularly the latter, which 
may be regarded as an exaggeration of other symptoms. There 
is often blended with it haziness of intellect, self-absorption, 
love of solitude, distrust of friends, and exaggeration of trifles. 
There is often associated with those mental states neuralgia 
and hysteria. They are most frequently periodic, correspond- 
ing to the monthly flow ; at which period she becomes very 
gloomy, indolent; scarcely speaks, and imagines a fancied 
evil is about to befall her. This condition generally continues 
for three or more years after the change. This. symptom is a 
most common one, often well masked and hidden by the lady ; 
her sensitive and loving nature is disturbed when all is 
changing around her, and she feels cord after cord snap that 
anchored her to life; and she, if she has sufficient strength of 
mind, will conceal her condition. The flame of vitality cannot 
die without forebodings of decay, and there may spring up 
doubts about faded charms, failing energy, changed aspect she 
never before harbored, whether now she may be able to retain 
the affection of husband, the sympathy of friends, the admira- 
tion of the world. Because the strength, the vigor, the vivacity 
of youth is gone, some women try to convince themselves that 
they are useless, and make themselves miserable. If unmar- 
ried, this change tells her to put aside long-entertained visions 
of future bliss. 

Apathy and sudden change of habits; dislike to exertion, mental 
or physical, with want of sleep ; melancholy and suicidal 
tendency. 

There is often a remarkable perversion of the moral nature ; un- 
controllable impulses to do things which they know to be wrong; 
often ungovernable, eccentric, reckless, extravagant, and in 
other cases avaricious. 

The temper is strange, peevish, snappish, quarrelsome, inva- 
riably uneven. 
The nervous system at the change is in such a state of per- 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 569 

turbation ; there is an insatiable desire for alcoholic drinks ; a 
true dipsomania. 

An Impulse to Deceive. — Women always surpass men in 
their stupendous powers of deception. When a man has an 
object to gain he may deceive; but he does not, like a woman, 
find a pleasure in deceiving for deception's sake. Untruthful- 
ness is very common, and it is not to be wondered at, under the 
mental perturbation present. Delirium, vertigo, distorted ideas, 
and false notions are crystallized with deception. 

Kleptomania, or a desire to steal, is very common at puberty, 
during disordered menstruation, pregnancy, puerperal con- 
ditions, and at the change. It is most unaccountable, this 
impulse to steal, at all risks, at the critical period. 

Homicidal Mania. — A tendency to kill is a lamentable con- 
sequence of the change. 

Suicidal Mania is common at puberty, and recurs at the criti- 
cal period ; less common in women than in men ; one woman 
to three men being affected. In women it is associated with 
the notion that they are possessed with the devil. 

Eromania, or inordinate desire for sexual gratification, is sug- 
gested, promoted, and intensified by morbid ovarian influences, 
uterine affections, and brain irritation. Woman, at the change, 
is an irresponsible being, being afflicted with some form of in- 
sanity; the disturbance of the abdominal brain reacts upon 
the brain proper. 

Apoplexy, Paralysis, in all their forms, are common at this 
period. In apoplexy, there is the vertigo, the specks and spots 
before the eyes, the noises in the ears, the choking. In paraly- 
sis, the numbness, the feeling of pins-and-needles, the loss of 
sensation and motion, coming and going in a part, or the whole 
of the body. 

Nearly all women suffer from neuralgia, as well as paralytic 
symptoms, most common about the small of the back ; lumbago 
in the abdomen all the time, or it may be simply monthly ; 
ovarian pain, colic, numbness, paralysis, sciatica ; numbness in 
the hands, arms, feet, and other parts ; neuralgia of face, loss 
of voice, deafness, toothache. Nearly every woman, at the 
change, suffers from one or more of the above symptoms, and 
an endless variety not enumerated. 

The pains in the back, or loins, and legs, are the most com- 
mon, and are generally described as radiating from the back, 
and an aching, numbing, gnawing, dragging, burning, or 
grinding. Often a sensation as if the back was broken through 
entirely. These backaches are often associated with pain in the 
ovary, or abdominal neuralgia ; numbness ; pricking sensation 
in feet and hands ; loss of power of parts are common ; burning 



570 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

sensations, with numbness in arms, back, and temporary loss 
of power ; neuralgia of the eyes. 

There is a whole host of affections that attack the reproduc- 
tive organs at the change, independent of flooding and leucor- 
rhoea. There is a remittent form of menstruation; vaginitis; 
follicular inflammation of the vulva; inflammation of the 
labia ; ulceration of the neck of the womb ; induration and 
enlargement of the womb ; falling of the womb ; uterine polypus ; 
cancers; tumors; ovarian disease; irritation of the breasts; 
milk, or glutinous secretion from the breasts ; copious phos- 
phatic deposits in the urine, with often inability to hold it; 
bloody urine ; erectile tumor at the mouth of the urethra ; 
rectal trouble ; piles; abscess; burning in womb and rectum. 
There is not much disposition to acute inflammation, as the 
general condition of degeneration going on protects the organs. 

Itching about the vulva, or pruritus, is very common, and is 
due to the sugar in the urine at this period of life, and to that 
coming in contact with the parts. 

Eczema on the lips makes the life of a woman unbearable. 
Prurigo and follicular inflammation begin at the change, and 
continue, in spite of best treatment, for several years. Herpes, 
or tetter is another annoyance. 

The great prevalence of vaginitis is to be explained by the 
continuance of sexual intercourse. Some cases are due to 
morbid states of the blood. A failure of health, gout, and ex- 
tension of eczema up the vagina, or acrid discharges from the 
womb, which are muco-purulent, greenish, or yellow, or slightly 
tinged with blood, and more or less offensive and contagious. 
Vaginitis gives rise to heat ; bearing-down pains ; disturbance 
of bladder and ovaries. 

The symptoms of change in the reproductive organs are 
manifold. The ovaries rule supreme over menstruation ; and 
if there is any disease laying quiescent, as a nucleus of a 
tumor, it will either retard, or give increased activity to the 
change. From thirty-five to forty-four years of age, when 
cessation begins to dawn in most women, sexual desire is less 
intense ; the married have fewer children, and the unmarried 
think less of marriage. This diminution of sexual energy 
accounts for a great decrease in the number and intensity of 
inflammatory uterine disease. Many women begin ths change 
of life with uterine disease that has been undetected, or im- 
perfectly cured, and all such conditions are likely to be intensi- 
fied, or aggravated by the change. Failing health gives rise to 
an exfoliation of the glands at the neck of the uterus at the 
change, so that the neck enlarges ; becomes 'soft, baggy. The 
change is often suspected by disease in the womb, or other 
parts ; but after the change, the uterus is not liable to the old 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 571 

diseases of its active state. Disease is rare after, and when it 
does take place, it is a residuary legacy from old times. 

The obliteration of the neck of the womb, with the altered 
shape of the womb, vaginal prolapse, falling, uterine tumors, 
fibroid, fatty, and mineral degeneration, are quite common. 

Women, with cancerous germs lurking in the system, are 
extremely apt to have them grow between forty and fifty ; 
although cancer, between thirty and forty, is very common. 
The influence of the change on cancer is to give it an impetus, 
a start ; to give it a rate of progression. The average duration 
of cancer here is sixteen months. 

Swelling and irritation of the breasts commence at the change ; 
they swell, become painful, nipples sore, oozes out serum or milk, 
or a gelatinous fluid, or a watery, bloody discharge. Tumors 
now put in an appearance ; cancer, if the germs are present in 
the blood. When the lacteal ducts and connective tissue are 
disappearing, fatty or adipose tissue becomes very abundant, 
and there are apt to be lobules of that tissue thrown out. 
Although disease of the kidneys is rare at the change, still 
there may be bloody urine, continence or incontinence of urine, 
and chronic inflammation of bladder. 

Two-thirds of all wom,en, at the change, suffer from some irritation 
of the stomach, liver, bowels, as dyspeptic symptoms, toothache, 
swollen gums, vomiting of mucus, blood; biliousness, jaundice, 
constipation, diarrhoea, inflammation of rectum, and enlarged 
abdomen. 

Biliary derangement at puberty, and its recurrence at the 
change, is the most com Dion of all the disorders of the ali- 
mentary tract. A very large number complain of being bilious ; 
bitter, metallic taste in mouth, with headache, nausea, and vom- 
iting ; bile in urine, and jaundice. This liver-irritation gives 
rise to the burning in the rectum, and piles, which are often so 
troublesome. That piles should be a common symptom is not 
to be wondered at, when we see the unrelieved plethora of the 
liver at the change, and when we bear in mind that the liver, 
intestines, and reproductive organs are covered by ganglionic 
nerves ; that the womb and all the viscera are supplied by 
nerves from the cord ; that the veins of the liver, uterus, and 
rectum are identical and continuous ; it is not surprising that 
when the uterine discharge is arrested, that the nervous energy 
and sanguineous current should flow by the intestinal surface, 
and give us bleeding piles. The swollen gums, dyspepsia, diar- 
rhoea, constipation, spitting of blood are generally periodic. 

A permanently enlarged abdomen is very common at the 
change, and is accounted for in two ways : (1.) by the increased 
deposit of fat in the omentum and in the abdominal walls ; (2.) 



572 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

to some extent, by an enlarged, inflated state of the bowels, 
without either diarrhoea or constipation being present. 

The Skin gives decided, infallible indications of the change 
in every woman ; it loses its softness, its elasticity, its fullness, 
and shrinks, and becomes withered and wrinkled ; then there 
are the heats, the sweats, the local burnings in hands, feet, 
legs, painfully hot; aching in the finger-nails, just as if they 
were being pried off, a peeling, a rotting of the nails. Besides 
these, there are various eruptions often present on the skin, 
as nettle-rash, erysipelas, eczema, blood-spots, tetter, prurigo; 
swelling of face and legs, either monthly or all the time ; vari- 
cose veins ; ulcers on leg ; boils everywhere, but especially about 
the seat; abscess in the fingers, armpits, neck, groin; sensa- 
tions of insects in skin are very common ; peculiar exhalations 
from the skin are not uncommon ; chronic rheumatism and 
gout, enlargement of the heart, chronic peritonitis, dropsy, are 
common at the change; ulcers, varicose veins, goitre, dis- 
charges from the ears, nose, mouth, and nipple are very often 
present; swollen gums, sore mouth, salivation, periostitis of 
the small bones, and other chronic affections more rare. 

There is a long list of other symptoms : the long-continued, 
persistent debility, with regular monthly pain in ovary or 
womb, with laughing and crying fits, and intense burnings, to 
which so little attention is paid ; the irritable rectum, with tenes- 
mus ; habitual oozing of mucus, or pus, or blood, is too often 
not attended to. 

The most common cause of delay of change, and conse- 
quently, prolongation of symptoms, is to be found in congestion 
and enlargement of the body of the womb, and this uterine 
enlargement, which delays cessation, is generally the result of 
sexual excesses, or frequent abortions. This very state, irre- 
spective of hysteria, may give rise to spurious pregnancy at the 
change. 

If the patient is free from disease, and has led a temperate 
life, the rule, "like puberty, like change," will hold good, not 
otherwise. 

The change is greatly modified by temperament, by constitu- 
tional peculiarities or eccentricities, social position; and these 
modify all symptoms, from the debility and heats, to the prick- 
ing sensations in feet, numbness of extremities, trembling of the 
limbs. Some imagine that the unmarried are more liable to 
flooding, cancer, ovarian tumors, at the change, but this is not 
true; the single pass over this critical time with much less 
trouble than the married, and suffer less. Women of loose 
habits, given to promiscuous sexual indulgence, prostitutes, 
those who resort to abortions, suffer immensely — words are 
inadequate to describe their sufferings. Such states keep up 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 573 

more or less inflammation through life, and predispose to much 
trouble at the change. Marrying late in life is also bad ; those 
sexual states maintain congestion of the sexual organs, and are 
eminently calculated to aggravate all the symptoms enumerated, 
as congestion and ulceration of the womb, if it exist. 

Terminations. — Change of life in woman, at whatever age it 
occurs, is a final settlement, and exercises its sanative influence 
on the rest of her life. When it is effected, her mind emerges 
from a cloud, in which it has for some years been lost. All 
ladies, while avoiding causes that would be likely to give rise 
to congestion ol the womb, should sustain their intellectual 
faculties well, read history, train their minds to take comfort 
from the fact that the period is past, which gives them an immu- 
nity from the perils of child-bearing, and the tedious annoy- 
ance of monthly restraint, thankful to have escaped real suf- 
fering. Women should not torture themselves into imaginary 
woes, but they should feel the ground steadier under them ; 
they are now less dependent on others, and their mental facul- 
ties assume a more vigorous and masculine form. 

The change of life does not bring talent, but it imparts the 
power to bring out latent faculties that have been for years in 
abeyance. The subsidence of ovarian action depresses one form 
of love, — those emotional impulses which give passion energy ; 
but at last, when the heart becomes capable of listening to 
reason, love still rules paramount in the breast of woman, and 
whether it is called charity, friendship, affection, conjugal or 
maternal, it is still there. Sound religious ideas often become 
engrafted, and take a sure hold, covering the evening of life 
with unanticipated happiness. When once over, and anchored 
in this new haven, a woman looks back on the time when her 
health was disturbed by ever recurring monthly trouble, and 
her mind distressed by delusion and passion. The importance 
to a woman of the change is great ; she is healthier, lives longer, 
less risks to life, becomes stronger, and enjoys a great free- 
dom from disease. It is said that a woman at the change loses 
all her personal attractions; but this is not so. The beauty of 
childhood appeals for a fostering care; the beauty of youth 
fascinates ; that of mature age excites admiration ; but in most 
women, after the change, there is an autumnal majesty, so 
blended with amiability, that it charms all who approach within 
its magic circle. Her sphere is wider, her social influence greater, 
her field of usefulness extended, and now is her time for intel- 
lectual pursuits and efforts. The cultivation of the mind, and 
its endowment with scientific lore, usurps the place of faded 
charms. Now woman becomes the guide, the mainstay, the pillar 
of strength to man in the difficulties and struggles of life ; she 



574 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

harmonizes society, unites its discordant elements, and stimu- 
lates the race to great, noble, and laudable ambition. 

Time may dull the eye, rob the cheek of its bloom, indent fur- 
rows on the brow, but it cannot smother the seraphic fire burn- 
ing in the hearts of women, prompting them to console, heal the 
deep and ever-festering wounds that afflict society. Those who 
have attained their sunset, without having been granted the 
anxious though desirable vicissitudes of wedded life, destitute of 
relatives and friends, may find in the philanthropic efforts of 
alleviating suffering humanity a grateful channel for their 
affection. Some women, at the change, are perfectly unstrung, 
unnerved, find themselves solitary and alone in the world, bereft 
of the s}anpathy of friends. Travel, occupation, history, religious 
duties capable of engaging her attention should be inculcated 
The continued friction of sound duties restores peace and har- 
mony, prevents brooding, self-absorption. 

Isolation causes everything to lose its natural and real appear- 
ance and to shine with morbid tints, and should be sedulously 
avoided. 

Social Position. — The position in life exercises a special 
influence at the change of life. Women who live in a natural 
way, keep regular hours, avoid reading trashy or fictitious liter- 
ature, exercise moderately, do not tight lace, and keep their 
health good, suffer comparatively little, except it be from the 
flushes and minor symptoms. Women in moderate circum- 
stances get along the best ; they are much freer from the symp- 
toms than the spoiled and petulant daughters of the wealthy 
lords of civilization. The necessity for working hard, the 
struggle, the anxieties of poverty, the impossibility of escaping 
these, in our abnormal condition of society, together with in- 
sufficient food, insanitary states, increase the sufferings of the 
poor at the change. 

Certain occupations have a good or bad effect: thus, sewing- 
machine operators and washerwomen suffer most ; the move- 
ment of the leg, in the one, keeps up ovarian irritation ; in the 
other, the changes of temperature to which they are exposed, 
are highly deleterious. The close, damp, heated rooms in 
w 7 hich mill-operatives, book-folders, catgut-workers, etc., work, 
increase their sufferings at the change. Hard work has its merits, 
it cures the nervous affections which assail the rich at this 
period of life ; for luxury, ease, lounging on sofas, in shut-up 
rooms, is the hot-bed of nervous affections ; there they grow in 
profusion and run into extravagant eccentricities. Few ladies 
are compelled to work in a heated atmosphere so injurious as 
the heated ball-rooms of the aristocrat. We would say to the 
rich and poor alike, that the best way to approach the change, 
is to get right down to a natural base in all things, and thus 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 575 

approach the critical period with a sound constitution. A con- 
dition of debility, which is the result of all excess, prevents 
the regular succession of vital phenomena, by which the criti- 
cal period is carried out ; and as the change is marked by de- 
bility, when this is grafted on constitutional weakness, loss of 
power, ill health will be of long continuance with a train of 
nervous disorders. With those states of urgent debility present, 
there is not stamina enough left to carry them through the 
changes successfully. All constitutional affections, all forms 
of diseased blood, are increased by the change. 

Prognosis. — Menstu ration is a useful guide for the changes : 
as it is ushered in so the change ; storms at puberty will real- 
ize a stormy change. Diseases that preceded menstruation are 
likely to attend the change. Skin affections, as eruptions of 
all kinds; hysteria, epilepsy, bleeding at nose, discharges from 
the ear, boils, diarrhoea; erratic pains before puberty, same con- 
dition before change ; faintings, want of strength, prevents the 
succession of vital phenomena and are likely to re-appear. 

Puberty does not always bring health ; there may be a lack of 
development, which may produce conditions that incapacitates 
for exertion ; her mental faculties may be lost in dreamy for- 
getfulness ; nervous irritabillity may give rise to fretfulness of 
temper, waywardness of disposition, mischievousness. The 
conbuct of some girls at puberty often betrays a dereliction of 
all principle. There may be some jar, or want of harmony be- 
tween the action of the reproductive organs and the nervous 
system, so that the flow may come on, on the fifteenth or 
twenty-first, instead of the twenty-eighth ; same troubles at 
change. 

Sisters are a fac simile of each other as a rule ; observe the 
same date, have the same peculiarities, same crisis, same com- 
plaints ; as biliousness, headaches, mental condition, everything 
the same at puberty ; same at change. 

The plethoric and sanguine suffer most ; very much more 
than the bilious and nervous, and chiefly from flooding and 
heats, and have a hard road to travel. A girl at ten, without 
any sign of cerebral or gastric disease, may manifest either a 
sleeplessness, or drowsiness ; the result of the premature action 
of the ovaries on the nervous system ; the precocity of the 
ovaries are very productive of nerve affections several years 
before menstruation takes place. Great irregularities and suf- 
fering at any period are warning symptoms of a change at any 
age. If the ovaries work well and smoothly at puberty, and 
the patient lives natural, follows physiological laws, the change 
will be un embarrassing, irrespective of age. It must ever be 
borne in mind that it is only the minority of women who suffer 
those innumerable difficulties and obstacles at the change • 



576 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

the large proportion pass the ordeal with little or no suffering. 
Well-regulated habits, healthy exercise, good moral and 
religious surroundings, an avoidance of tight lacing, of balls, 
late hours, unhealthy society and, literature. Women, from 
want of instruction suffer much ; they are ignorant of what 
should occur, or form exaggerated notions of the perils that 
await them, and receive no help from their medical attendant, 
because he is ignorant of their suffering. 

Let it, therefore, be clearly understood, that if in tolerable 
health, and with ordinary care, that they have only blessings 
to expect from the change of life. We say that the critical 
period is very dangerous to the tight-lacer, the dime novel 
reader, to the ailing, to the dancer, to the lazy, to the habitual 
sufferer at the menstrual period, to those suffering from uterine 
disease, to epicures, for ices, improper food, sitting on door-steps, 
sewing-machine operators, and sexual excesses. Very great diffi- 
culties are likely to arise from marriage at the change, especially 
if for the first time. Such a state at the change causes the womb 
to become congested, and it increases in size four or five times. 
If marriage is desirable, postpone it, hold it off till after the 
change has been consummated. 

Diagnosis. — Have we means of foretelling the change, and 
recognizing it when completed? Assuredly we have. The 
change can be predicted after forty, if there is a gradual dimi- 
nution in the quantity of the menstrual flow, a gradual pro- 
longation of the inter-menstrual periods, an occasional flooding, 
with heats and other symgtoms ; but the grand land-marks are 
not this gradual cessation, or at once, but in the organic changes 
that take place. The uterine wave disappears ; the ovaries are 
shrivelled, withered, crumpled up into a peach-stone shape ; 
obliteration of fallopian tubes ; atrophy of the womb, becomes 
round, its neck grows shorter, and thinner, and disappears ; 
vagina becomes narrow and short ; coldness of the parts, from 
a shrivelling up of the pampiniform plexus ; atrophy of the 
breasts ; hairs on the upper lip, with vertical creases ; stray hairs 
on the face and chin ; and a peculiar, masculine physiognomy. 
There is a prevailing, all-pervading debility, which cannot be 
accounted for by disease ; the complexion is pale, or sallow, a 
drowsy look, a sort of stupid astonishment, as of one seeking to 
raise herself to answer a question ; always some irritation of 
the brain, which shows itself in a knitting of the brows ; the 
disappearance of the menstrual flow, or its irregularity, or scanti- 
ness, or its too great abundance. Cessation is to be looked upon 
as positive, whatever be the age, when the above conditions are 
present, unless accounted for by nursing, pregnancy, or uterine 
disease. At forty-five it is a settled fact ; but, in order to com- 
plete the diagnosis, it is well to add, the debility, the unusual 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 577 

heats, the sweats, the appearance of discharge dirty brown, its 
total disappearance, and the other symptoms already enume- 
rated. 

The sanguine or plethoric exhibit unmistakable indications 
of a great aggravation of all the leading symptoms ; whereas, 
the nervous, with their white faces, ever-anxious, nervous look, 
suffer least. 

Cessation should never be mistaken for chlorosis, inflamma- 
tion of the womb, uterine polypi, uterine tumors, uterine cancer, 
pregnancy, either spurious or real, or other eccentricities of the 
uterus. 

Some diseases induce early changes in a woman's nervous 
system, and render her barren or sterile, such as the cholera 
germ, typhoid germ, the germs of pernicious, malarial, or yellow 
fever, the germs of diphtheria : under these the ovaries wither, 
and change takes place. Blows on head and back, fright, etc, 
we have already alluded to, and they should be weighed in the 
diagnosis of some cases. 

Treatment. — As ladies approach the change, it behooves 
them to prepare for the crisis — to get rid of all little ailments or 
disease; to observe and carry out a special regimen, and, so far 
as possible, to so arrange themselves as to be ready for emergen- 
cies ; eat the best of food, observe hygienic laws, and place them- 
selves upon a course of alteratives and tonics, such as we will 
subsequently lay down. Those two kinds of remedies are spe- 
cially useful at the change. Alteratives are particularly indi- 
cated, to aid the change, to rouse up all the glands, to relieve the 
system of all waste, or effete, or waste-matter ; and tonics, to aid 
in bracing up. In prescribing alteratives, it is necessary to guard 
against the prejudice, firmly rooted in the minds of many, that 
the change of life is synonymous with old age, w r hich is not so; 
for the ^ery prime part of a woman's life is before her, and at 
the change all ladies are benefitted by alteratives which are not 
suitable for advanced years. Both at puberty and change, 
which are periods of a new birth, there is strong vital energy ; 
it may be latent, but it is there, and the use of alteratives, 
which cleanses the blood, develops unexpected strength and 
great vigor, and is strictly in accordance with natural laws and 
the phenomena of the change. But before calling attention to 
those, we will lay down, briefly, the essential elements, in a 
dietetic, hygienic, and medicinal view, that should, as far as 
possible, be observed at the change in all cases, and then briefly 
allude to remedies for the predominant symptoms. 

Diet. — Women, at the change, should eat plain food, as milk, 
eggs, boiled white-fish, broiled beef-steak, or chops, chicken, 
game, bread, butter, oatmeal porrige and cream, vegetables of 
all kinds, and an abundance of ripe fruit ; the latter to be used 

49 



578 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

freely, and to an extent not interfering with digestion. All 
farinaceous, or starchy food, or sweets, as puddings, tapioca, 
rice, pies, cakes, pastry, tend to load the system with carbon, 
and thus generate heat ; prolong sleep ; cause distaste for exer- 
cise, and a tendency to stoutness. Forbid, in all cases, the use 
of sugar, tea, spices, pepper ; all stimulants, together with shell- 
fish, salted fish, or bacon, ham, corned-beef; malt and alcoholic 
stimulants. Coffee to be used with moderation. 

Women who have a tendency to become stout, require less 
food and more exercise than the lean. If there is great languor, 
weakness, nervousness, the diet should be made very generous, 
and the tonics increased. With the above diet, women will 
tide over the change well and have no further unsettlement of 
health to fear. If, however, women go in for eating heavy 
meals, stimulants, and excess, they will become like men, and 
have another change to meet after sixty-five. High living, 
and stimulants at the change, gives rise to early degeneration, 
which begins first in the capillaries, and steadily progresses to 
the larger vessels; then to the heart, spleen, liver, kidneys; 
and this degeneration is characterized by an increase of fat; a 
non vital substance in the omentum, in the abdominal walls; 
and, as a result, the belly becomes large, protuberant, pendulous. 

Clothing and Bathing. — Whatever the season of the year may 
be, or locality, or condition in life, flannel should be worn next 
the skin, at all times, to protect the surface from changes, to 
absorb perspiration, so as to prevent being chilled. Bathing 
the entire surface daily cannot be omitted, as it is a great 
safeguard ; its neglect gives rise to great suffering. We might 
say it is imperative, for the skin is heavily loaded with waste 
matter. Warm baths are the best, as they remove from the 
skin copious saline deposits, and other secretions left there by 
the heats, or the perspirations ; besides, being in a warm bath 
for three-quarters of an hour, enables the skin to absorb mois- 
ture, or water, which allays the cutaneous irritation, and dilutes 
the blood. The warm alkaline bath is like a gigantic poultice, 
applying its warmth to all the peripheral expansion of nerves, 
so that it becomes a splendid sedative to nervous irritability. 
It is perfectly manageable in all cases ; temperature increased 
or lowered at pleasure ; and even while in the warm bath cold 
can be applied to the head, or a cold shower to the abdomen ; 
or by a long-tubed syringe cold water could be thrown up the 
vagina or rectum to relieve uterine congestion. The alcoholic 
vapor-bath about twice a week ; on other days the hot, or warm 
bath for over half an hour, followed by brisk friction, is always 
of utility, and, in some cases, it is well to follow up with 
massage. 

In a small number of cases cold bathing is useful, provided 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 579 

there is vitality enough for reaction. The mineral water baths, 
whether of the sulphurous or alkaline kind, are always of the 
most efficacious character. Sea-water is not of so much benefit 
unless warm. 

Exercise of the muscular system relieves the congestion of the 
internal organs ; it depletes, causes the skin to perspire, the 
kidneys to work actively, and eliminate uric acid freely ; it 
rouses the liver to action. It should be taken in the mornings ; 
should be moderate, not continued to exhaustion ; long walks 
are objectionable, it should just be enough to carry off the 
redundant energy, which, when unemployed, or not wrought' 
off, givei rise to fidgets, nervousness, and temper. Driving is 
excellent ; but horseback exercise should never be indulged in 
at this period. 

Change is most beneficial in all things. There is nothing 
that conduces so much to mental and physical vigor as change. 
It is a great strengthener of the nervous system in particular. 
Traveling places the patient in a new sphere; new scenes; 
new ideas, every one of which makes a call on her attention, 
solicits her interest, captivates her faculties, completely lead^} 
her away into new fields of thought ; away from old habits and 
associations to which she had been long and painfully chained. 
Change has a most salutary effect on the brain ; under it the 
mind is consoled, and resumes peace and tranquility. Nothing 
so vitalizing ; nothing so serviceable for the cure and preven- 
tion of disease at this critical period. 

Fresh air is indispensable here ; there must be an avoidance 
of close rooms, badly ventilated apartments, insanitary sur- 
roundings; the bedroom windows open at top and bottom. 

Amusements. — The ordinary cares of the household are at this 
period a burden ; there should be, if possible, a general easing- 
up, a lay-off, or rest. The mind could be occupied with reading 
history, because exciting stories, which are present in novels, 
induce nervousness of some shade or type; besides, excitement 
is injurious. For this reason, balls, parties, concerts, operas, 
theatres, are excitants, and the impure air breathed in those 
places, in addition to their moral effect, causes them to shock 
the impressible, susceptible nervous system, and renders the 
patient sleepless and irritable. All exciting agents are dele- 
terious, being productive of continued irritation and want of 
sleep, and it must ever be borne in mind that continued sleep- 
lessness is the precursor of insanity. Night after night at 
theatres habitually subjects the mind to an increased intensity of 
feeling, which in the silence, solitude, and darkness of the night 
that follows, destroys its sensibility, and eradicates its typical 
fissures. All amusements should be of the most stable and 
healthy kind. 



580 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

Hygiene of the Reproductive Organs. — This is a most important 
consideration at the change, when those organs become atro- 
phied and shrivelled up. Nature emphatically points, by this 
very condition, that their appropriate stimulus should be 
avoided, and it is neither wise to marry nor to have congress 
at this unsettled period of life. Connexion at the change brings 
about uterine disorders and grave complications. Some assert 
that the sexual appetite is strongest at the change ; that the 
flickering flame of sexual desire gives rise to a final blaze ; that 
there is increased ardency. This no doubt occurs once in a 
while, but it is rare; the opposite condition is the natural one, 
merely a distaste for connexion at that period. A marked 
increase of sexual impulse or ardency at the change is a mor- 
bid desire, depending upon a condition of congestion of the 
ovaries, spinal cord, or brain. The sexual act aggravates the 
trouble, and leads to serious complications. No woman should 
marry at that crisis ; defer it till it is over ; because if performed 
it will result in flooding, uterine disease, the development of 
uterine cancer, etc. 

Having regulated the general condition of the patient, she 
should be placed upon a general alterative and tonic course of 
remedies for at least five or six years ; she does not want many 
remedies, only a few, but they should be good ones; but in all 
cases she should persevere with them faithfully, changing them 
at regular intervals of every seven days; and with those breaks 
the same remedies can be resumed again and again with great 
efficacy. 

The best alteratives at this period are the saxifraga ozonized 
compound, the mother's cordial, the viburnum compound, and 
the ozonized phytolacca. Select two out of the above list and 
give in the usual dose about two hours after meals, and change 
weekly. If the patient is in very straightened circumstances, so 
that she is unable to procure those invaluable alteratives, let 
her do the next best thing, make infusions of blue flag, tag alder, 
yellow dock, and take them instead, so as to aid the elimination 
of waste-matter from the body. 

The best tonics at the change are the Peruvian bark, white 
mustard seed, the glycerite of ozone, kurchicine, golden seal, 
gentian, etc. Of these the Peruvian bark and white mustard 
seed are the most efficacious ; the crude bark is better than its 
finer preparations : one ounce of the bark to one pint of good 
port wine, to which add one ounce of the elixir of vitriol ; allow 
the whole to settle. Dose, one tablespoonfull three times a day 
one hour before meals. In some cases leave the elixir of vitriol 
out, then it can be given in wine-glassfulls three times a day 
before meals. The compound tincture cinchona and mineral 
acids is excellent. At all events, don't deceive the patient by 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 581 

worthless and inefficient preparations of the bark, nor delude 
her with tasteless infinitesimal sugar globules. There is a 
gigantic, a grave change to be aided, shattered vital force to be 
restored, and it must be effected on the principles of common 
sense. 

Next in efficacy, as a tonic, is the white mustard seed. This 
is one of the valuable remedies at the change. It is particu- 
larly useful to meet the symptoms of debility in a worn-out 
constitution ; invaluable if there be indigestion, or liver trouble, 
with heartburn, pain or cramp, or a numbness, or a failure to 
sleep, nerve-tire, prostration. The Peruvian bark stimulates 
the brain ; favors the making of red blood, and is slightly 
astringent ; whereas the white mustard seed operates in a most 
extraordinary manner in disorders of the organs of digestion 
and assimilation ; on the stomach and liver specially ; stimu- 
lates the ganglionic nerves laying over the womb and ovaries ; 
corrects all irregularities, and improves the general health. It 
is a valuable tonic, stimulant, and aperient; strengthens all 
the organs in the abdomen ; imparts activity. The efficacy of 
the seeds does not depend on any specific power, but from the 
vitalizing energy which they impart. This is due to a volatile 
oil which exudes through their skin while in the bowels. The 
seeds must not be masticated, but swallowed whole ; and they 
can be given continuous for the five or six years of change 
without the patient becoming habituated to their use, regularly 
three times a day without leaving off, the patient feeling better 
and better all the time. There is no better remedy at the 
change — not one that can excel it. It relieves that indescribable 
feeling of debility and languor ; overcomes drowsiness ; soothes 
the irritable ; strengthens ; invigorates ; increases assimilation 
one hundred per cent., and aids the vital forces under the 
terrible prostration, enabling them to hold their own by its 
effect on the nervous system. To ladies who need constant 
help it affords great relief; inestimable benefit. It should be 
taken one hour before meals, three times a day, in one or two 
teaspoonful doses, always exercising care not to bruise the 
seeds. It never fails to afford great amelioration. Its gentle 
action on the bowels is very salutary, as it is always important 
that bowels and skin should be stimulated. The glycerite of 
ozone operates well in all cases, and combines the action of both 
tonic and alterative. The extract of kurchicine is also a very 
valuable tonic. Infusions of golden seal, gentian, collinsonia, 
wine bitters are good tonics, but not of much utility at the 
change. Next to the Peruvian bark and white mustard seed 
may be placed the kurchicine. All tonics are best given one 
hour before meals. In ordinary cases the above simple altera- 



582 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

tives and tonics are all that the great proportion of cases require, 
and can be readily carried out by the patient herself. 

But in addition to these there are often met a train of symp- 
toms, some of which are present, and require special remedies 
and management. To these we will now solicit attention. 

Nervous Debility. — This debility at the change is peculiar; 
sometimes it depends on an excess of blood, and in other cases 
upon too little blood. If it depends on an excess, for which 
there is no drain, it is a good plan on the first appearance of 
irregularities which characterize this period, to curtail rather 
than augment food. Debility, when in the family way, or 
nursing, is benefited and often overcome by a very liberal and 
generous diet ; but at the change this surplus blood cannot be 
utilized. In some cases it is advisable to establish a drain by 
applying two small blisters, about two inches square, on each 
side of the nape of the neck for six hours, every second or 
third day, so as to keep up a slight discharge. These off and 
on periodic blisters to the nape of the neck are of great utility 
when disease-germs are suspected to exist in the blood. 

In debility, with anaemia or poor blood, there must be more 
and better food, with rest, and a free use of the tonics already 
laid down. It is almost useless to experiment with others. 
Preparations of phosphorus, although very strengthening, 
imparting keenness and vivacity to the mind are contra-indi- 
cated, because they predispose to fatty degeneration of tissue ; 
of the heart, liver, spleen, kidneys. The same objection is to 
be urged against malt and spiritous liquors. Iron is not a good 
tonic at the change, as it increases the heats by retarding the 
action of the liver. If it is tried, the acetated tincture is to be 
preferred. 

Flushes of Heat. — The skin at the change suffers from flushes, 
heats, sweats, eruptions. They all pass of, as a rule, after the 
change. The flushes are the most tenacious, often holding on 
for years. Prurigo, or itching, or eczema are the most trouble- 
some, and are blended with the hot flushes; have their origin 
in the latter. In the treatment of them, it should be borne in 
mind that they are increased by emotion, nerve-shock, external 
heat, as in cooking, washing, ironing, baking, hot rooms, hot 
drinks, over-feeding. In arresting diarrhoea, leucorrhcea, flood- 
ing, over-clothing, all these, as far as possible, should be avoided ; 
the Peruvian bark mixture, the white mustard seed, are to be 
increased in dose ; the bowels to be kept rather open, and the 
usual daily warm baths scrupulously carried out. Various 
local applications, " cooling," should be applied, as bay -rum 
and borax, borax water, and the face, cheeks, neck, breasts, or 
other parts can be dusted occasionally with puff powders, which 
are very cooling, and contain no deliterious agent. 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 583 

In some cases the flushes are preceded by a chilly sensation, 
or coldness ; some even tremble with cold before the heats come 
on; others have associated with it aching in the nails. When 
sweats follow, it denotes great debility and.congestion of internal 
organs. Sometimes the flushes are anomalous, preceded by 
strange sensations in the skin, which in numerous cases resem- 
ble a beating, like an animal throbbing in the stomach, or the 
fluttering of a bird, sensations that disappear when the perspi- 
ration comes. Some women are living furnaces, and insist upon 
the doors and windows being left open in winter time, and woe 
betide delicate women compelled to live with them. 

In such cases good results follow the use of salines in alter- 
nation with preparations of sulphur, as the tincture, in twenty 
or sixty-drop doses three times a day ; or sulphur and cream of 
tartar; or sulphur, fine flour-sugar, and white resin. In other 
cases infusions of sassafras or yellow dock are of efficacy. 

Sweats. — These are simply evidences of great brain prostra- 
tion, sweat running off the forehead or the entire body, obliging 
the patient to change linen several times a day, and when in 
bed literally soaking the bedclothes. 

To a certain extent sweats are beneficial, they clear the body 
of superfluous material ; but when they are excessive they hin- 
der the insensible perspiration — that exhalation so necessary 
to health. Besides, when they are excessive they denote a pas- 
sive permeability of the skin, caused by a loss of nerve power. 
It is not well to check them entirely, as such a proceeding will 
cause internal congestion. 

Try such simple remedies as aromatic sulphuric acid and 
quinine, tincture of sulphur, or in some cases a tea of pleurisy 
root. 

Leucorrhoea. — This should not be stopped, although it is well 
to syringe out the vagina three times daily with infusions of 
white pond-lily, or witch-hazel, or strawberry leaves, and if 
there is any itching or burning, borax should be added. As a 
general rule, the injection should be tepid or cold. 

Hemorrhages from nose, mouth, ears, nipple, navel, ulcers, 
vagina, are common. If they are not excessive, mitigate them, 
but do not check altogether, as they are often salutary. The 
regular treatment by alteratives and tonics should be adhered 
to, but if they are violent or excessive try ergot, gallic acid, and 
port wine, digitalis, or the alcohol, turpentine, and sulphuric 
acid mixture. At the same time, if from the vagina, enjoin 
rest in the recumbent posture, head low, foot of bed elevated, 
cold drinks or ice in mouth, small sponges, saturated with vine- 
gar, inserted up vagina, and changed every three hours. Great 
care and good judgment should be exercised in its arrest. 

Headaches are often promptly relieved by guarana, four tea- 



584 DISEASES OF THE FEMALE ORGANS OF GENERATION. 

spoonsfull of the fluid extract every few minutes, or two or three 
grains of caffeine, or, that failing, a four-drop capsule or pearl 
of nitrite of amyl inhaled; these failing, treat it under the fol- 
lowing head : 

Sleeplessness, Giddiness, Drowsiness, with Headache, or Cerebral 
Neuralgia. In those depressing states, hyoscyamus is of great 
utility ; repeat till it affords relief. Hyoscyamus suits the nerv- 
ous disturbance of the change in a most excellent manner. 
The dose and its frequency of administration will depend on 
the condition. When the pain is very great tr}^ croton chloral. 
If these fail, then bromide of potassa and bromide of ammonium 
are of utility, either alone or combined with chloral h} 7 drate, as 
follows: Take one ounce of camphor- water; three drachms of bro- 
mide of potassa ; one drachm of bromide of ammonium, and two 
drachms of chloral hydi ate. Mix. Dose, one teaspoonfull every 
two or three hours till relief is obtained. But if that fail, and 
nothing will allay the intolerable pain and giddiness, which ren- 
der existence unbearable, give morphia sufficient for the purpose 
rather than let the patient suffer. Sleeplessness, with cerebral 
neuralgia, at the change, often resists our best remedies, and it 
is necessary to tack around considerably, and only in the event 
of all remedies failing should the morphia be given, as at no 
period of life is a habit so easily acquired as at the change, so 
that with alcohol and opium we should exercise great care. 
Camphor is a valuable remedy in those cases; it stimulates the 
nervous sj^stem to increased action ; it corrects the toxic influence 
which the reproductive organs have upon the brains of some 
women ; it abates the sexual sting by acting on the cerebro- 
spinal nerves of the internal organs of generation, not on the 
ovary or testicle. Large doses of camphor to child-bearing 
women do not prevent conception, like bromide of potass, nor 
induce impotence, but simply appeases the excitement of the 
generative organs at the change. It may be given alone, or 
with lupuline from the hops. Sumbul or musk-root, tincture 
of green root of gelsemium, operate beneficially. The inhala- 
tion of the nitrite of amyl moderates cerebral irritability. Topi- 
cal applications to the head are often of great value; as, for 
instance, take two pints of water, to which add two ounces of 
liquor ammonia, one ounce of spirits of camphor ; mix, and 
apply to the head for fifteen or thirty minutes, or longer, and 
then remove and apply vaseline ointment. Or, another good 
remedy is to take two ounces of olive oil, the same of chloro- 
form, and half an ounce of menthol ; mix, and rub into the 
painful part. The irritabilitity of the brain at the change is 
caused by and aggravated with ovarian disturbance, and it is a 
good plan to use both rectal and vaginal suppositories of bella- 
donna and opium. Veratrum viride, and aconite may be given 



DISEASES OF THE FEMALE ORGANS OF GENERATION. 585 

with benefit if there is plethora. The same characteristic symp- 
toms, as headache, giddiness, drowsiness, are present at puberty, 
and at that period bromide of potass is inadmissible, and never 
should be given. 

During the change the brain is often unhinged, so that cata- 
lepsy, epilepsy, melancholia, hypochondriasis, insanity, apathy 
are present, for the management of which see those different 
heads. 

Clever women often lose confidence in themselves at the 
change, and are unable to manage their own affairs, and their 
moral treatment, for a few year?, requires great care. The dis- 
turbance of this crisis tells heavily upon her. Very frequently 
her mode of dealing with everyday occurrences of life betrays 
a want of principle, strongly contrasting with her previous 
rectitude, and a return to that untruthfulness that may have 
existed at puberty. There may also exist every idiosyncrasy, 
peevishness, irritability, ill-temper, ingratitude, passion, eccen- 
tricity. It is no uncommon thing for a high-toned Christian 
lady all through life up to the change to desert her husband 
and children for a scamp, while others make life intolerable by 
their tyranny and hate the long-cherished object of their 
affections. Some become moody, silent, gloomy ; neither loving 
nor hating. Others again, in the midst of wealth, talk poverty 
and indulge in a propensity to steal, while another class feel 
like committing grave crimes. The nervous system is unhinged, 
still it will pass away and must not be regarded and treated as 
insanity, for all the strangeness of temper, the fitfulness of 
spirits, the perversion of character will abate and disappear 
under* proper care. But the patient requires judicious care, 
removal from home excitement, new scenes, the intelligent 
sympathy of friends, and the support of strong minds. The 
most amiable at this time become annoyed with trifles, and are 
often passionate, quarrelsome, fretful by the slightest worry or 
excitement. Derangements of the stomach and liver are very 
common. This disturbance shows itself in every imaginable 
form of dyspepsia and biliousness ; the kidneys also suffer. The 
general treatment as laid down for those affections should be 
carried out, and nitro-muriatic acid and phosphate of soda 
given. Diuretics are very valuable and deserve attention. 

Diarrhoea is salutary and must not be hastily checked. Some- 
times useful to encourage by giving small doses of either of the 
following mixtures, say about ten or twenty grains thrice daily : 
sulphur, one ounce; calcined magnesia, half an ounce ; mix ; or 
equal parts of borax and sulphur. In some cases of diarrhoea 
great benefit accrues from the use of the liquor ammonia 
acetatis in teaspoonful doses as above. 



586 DISEASES OF THE BREAST. 



DISEASES OF THE BREAST. 



INFLAMMATION OF THE BREAST. 

The male breast, being in a mere rudimentary state of devel- 
opment, is rarely attacked with inflammation, but generally the 
female breast, and that also during the state of activity or lac- 
tation. True, we meet with cases in infants at birth with a 
secretion of milk, also in highly sensitive ladies during the 
days of menstruation ; and in others, from the period of concep- 
tion to the birth of the child, the breast manifests a degree of 
activity, and in some cases milk or serum is secreted ; but it is 
safe to say that mammitis is generally met with only during 
lactation. 

The predisposing causes are debility , great development of the 
sympathetic, which is reflected over the breast; hence emotions, 
passions, as worry, grief. The ordinary exciting causes are cold, 
blows, violence, irritation of corsets, external injury ; more rarely 
from sympathy with irritation of uterus, with which organ it 
is in direct connection, ovarian, gastric, hepatic, renal, intestinal 
irritation. . It may be either acute or chronic. 

Symptoms. — In the acute form there is the shock, with pain, 
swelling, and induration of breast, rigors and a fever, with 
prostration, rapid pulse, arrested secretions, often slight delirium. 
Arrest of secretion of milk and suppuration soon follow. 

In the chronic form there is enlargement of the gland and 
induration ; milk is either wholly or partially arrested. It may 
follow an acute attack, or come on by itself. It is more likely 
to occur at other periods than pregnancy and lactation. It may 
also terminate in abscess. 

Treatment. — In acute inflammation of the breast the best 
plan is to treat actively ; open bowels with repeated doses of 
salines; administer aconite, veratrum, and belladonna for fever ; 
and if patient does not perspire freely, compound tincture of 
serpentaria ; relieve pain with morphia ; milk to be drawn off at 
regular intervals by breast pump, and hot linseed poultices 
applied. If it is deemed best to arrest the secretion of milk, apply 
belladonna, iodide of potass, and muriate of ammonia, and keep 
bowels free with salines. This latter plan makes short work 



DISEASES OF THE BREAST. 587 

of the inflammation. Subsequently tonics, and good, nourish- 
ing food. 

In the chronic form keep arm in a sling, or quiet; free pur- 
gation with salines ; apply the belladonna during the night, and 
over all, compression with a roller round entire body; during 
day fomentations of hot vinegar, and nitrate of potass. If there 
is any milk, draw off. 

Constitutional treatment is of great importance, alteratives 
and iodide of potass. If suppuration take place, discontinue 
the above, poultice, and as soon as fluctuation can be detected, 
open freely, and administer tonics, and good food. As a result 
of both acute and chronic inflammation of the breast, if not 
managed with great care, we are liable to have abscess. 

ABSCESS OF THE BREAST. 

This also may be acute or chronic, the former a result of active 
inflammation, the latter of chronic irritation. The lymph that 
is effused in inflammation may be either in the substance of 
the gland, or between the gland and skin, or between gland 
and chest walls, and it is in those three locations that we find 
matter m abscess. It must always be preceded by inflammation 
and effusion of lymph. 

Symptoms. — In acute abscess, which occurs during the active 
stage of inflammation, the patient is seized with rigors, and the 
pain, which was intense and steady, changes to a throbbing and 
sense of weight; breast greatly engorged ; formation of a pain- 
ful point; by and by fluctuation. In the chronic form there is 
little local pain or constitutional disturbance. There is the local 
swelling or lump; rigors that come on at formation of pus 
scarcely perceptible; little throbbing pain can be detected ; mat- 
ter forms slowly. It is this form that is associated with debility, 
and occurs outside of the puerperal state of activity. The indu- 
ration, or lump, or mass of effused lymph, is often mistaken for a 
tumor. Even when pus forms, fluctuation is indistinct. 

Treatment. — If it is quite clear that no softening has taken 
place, then place patient upon alteratives and tonics, with best 
of food ; apply ozonized clay to the entire breast, leaving nipple 
bare, and over and above all a roller encasing the entire chest ; 
firm compression. If clay causes any redness, camphor, bella- 
donna, and lard, with iodide of potass ; when redness disap- 
pears reapply the clay. By this means the lymph will be 
absorbed. But if you are satisfied, either from the softening of 
the mass, or from rigors, or sweats, or throbbing, that the lymph 
has broken down, then by all means poultice with a lye poul- 
tice during the day, made of wood ashes and slippery elm, or 
slippery elm and bicarbonate of soda, and during the night lin- 



588 DISEASES OF THE BREAST. 

seed poultices and laudanum, supporting the patient well by 
food and tonics. 

The clay treatment, in the prevention of a breaking down of 
lymph, and preventing abscess, is most successful. 

DISEASES OF THE NIPPLE. 

The mammilla or nipple of the breast may be the seat of 
numerous morbid processes. Its peculiar anatomical character 
renders it liable to become the seat of diseased germs, so that 
we frequently meet with the germs of eczema, lepra, lichen, 
psoriasis, the colonies forming crusts, scabs, and the like, irri- 
tated or aggravated by corset bones (see Skin Diseases — Antiseptic 
Applications). During lactation, especially at the commence- 
ment, nipple is very apt to become tender, from mother permit- 
ting it to lie in child's mouth. Young or inexperienced mothers 
are not aware of the fact that the child should be nursed at 
regular intervals of two hours apart; that the child should empty 
breast perfectly, no milk left in it; because if there is, it will irri- 
tate the gland, dry up the secretion, so that the mother will 
become a poor or scanty nurse. When nipple is removed from 
the child's mouth it should be well dried, and care taken that 
no article of dress irritates it. Nursing mothers should wear 
flannel summer and winter, so that the breast be always covered 
with this vitalizing covering, so arranged as to permit breast 
to be easily uncovered. The practice of bathing the nipple 
the last two months of pregnancy, in order to harden it and 
prepare it for work, with port wine and bark, brandy, or astrin- 
gents, is not to be recommended among our ladies," who are 
highly civilized, whose nervous systems are keen, liable to 
impressions. When we look at the intimate connection of the 
nerves of the nipple and the uterus, such a practice is not likely 
to be followed by good results 

After a good, hearty meal the child's mouth should be washed 
out, so that no milk will decompose or become acid, and cause 
irritation. The degradation of the living matter concerned 
in either the nutrition of the nipple, or the mouth of child, in 
all irritations causes ulcerations, cracks, fissures, chaps, or abra- 
sions, furrows, and the disease-germ, oidium albicans, appears, 
which can be carried from the nipple to the babe's mouth, or 
from its mouth to the nipple, — a regular contagious disease, 
because there is a living germ present. The practice of mothers 
permitting friends, children, and others indiscriminately to kiss 
the infant never should be tolerated, as a large percentage of 
individuals have those living germs of disease in their mouths, 
or are affected with other germ-disease. 

If there is, then, nursing sore mouth or aphthae, then the 
above disease-germ is present, and it will require care, tact, 



DISEASES OF THE BR3AST. 589 

skill, and perseverance to get rid of it. The cracks and abra- 
sions about nipple are literally loaded with it. True, parra- 
citicides, as ozone ointment, or sulphurous acid lotion, or borax 
and glycerine, will destroy them, and if a rubber shield is worn 
when babe is nursing, they will heal up rapidly, but there must 
be care and watchfulness to prevent their recurrence. If there 
is a slight tenderness either in mouth or nipple it should be 
smeared over freely with the ozone ointment, or the borax and 
glycerine. 

The nipple is often found to be the seat of chancres, syphi- 
litic sores, mucous tubercles, and the like. Those are generally 
the result of direct inoculation, the application of a diseased 
mouth to the nipple. Mothers should be extremely guarded 
in permitting any child except their own to take the nipple in 
its mouth. Neither should any animal or individual take her 
nipple into their mouth on any pretext. The destruction of 
the germ with ozone ointment is sufficient, with constitutional 
treatment, in all cases. 

Cancer germs are often found on, in, or about the nipple of 
both males and females ; the buckle of the suspender in the 
former, and the bones of corsets in the latter, are exciting causes. 

MASTODYNIA, OR NEURALGIA OF THE BREAST. 

The breast, in ladies of high civilization and culture, with a 
strong nervous temperament, suffers from neuralgia. This may 
be due to blood poisons, or disease-germs, irritating the weak 
mammary nerves, or due to reflex states, induced by mastur- 
bation, uterine or ovarian irritation or disease. The inherent 
cause of the trouble is an organic weakness in the nerves of the 
mamma, This may be induced b} r a variety of causes, as occu- 
pation, corsets, operations upon the breast, and imperfect appo- 
sition of flaps, or bulbous condition of nerves, blows, sitting at 
benches, or toying with the gland. 

This condition of neuralgia exists without any structural 
disease of the gland. 

Symptoms. — Pain in the breast of a sharp, lancinating 
character, or it may be an aching, wearying kind, but usually 
like neuralgia elsewhere, acute and liable to exacerbations. 
There may or may not exist a slight puffiness, or swelling, or 
even an increase of temperature of the affected gland ; and 
even the lobules may feel rather firmer than natural. But it 
is more generally the case that the gland feels healthy to the 
touch. When due to uterine or ovarian trouble anaemia is 
generally prominent. In some women the breasts enlarge and 
become irritable; suffer from neuralgic pains at and during 
menstruation. In all cases there is some impairment of general 



590 DISEASES OF THE BREAST. 

health; nervous dyscrasia; loss of appetite; constipation; 
leucorrhoea ; restless nights ; anxiety. 

Treatment. — Immediate relief must be afforded of the dis- 
tressing pain ; for this purpose pulverized opium and hyoscya- 
mus must be given at intervals, and dry heat locally, followed 
by belladonna piaster to the entire breast. As soon as pain is 
relieved, the cure of the disorder upon which the pain depends; 
search carefully for malaria, mercury, syphilis, gout, rheuma- 
tism, anaemia, chlorosis ; but above all for ovarian and uterine 
irritation, and the greatest attention to diet of the best ; proper 
outdoor exercise; daily bathing ; flannel clothing, and regulated 
bowels. 

Alteratives and tonics, embracing ozonized phytolacca, or 
saxifraga, iodide potass, iodide of lime, glycerite of ozone, and 
kephaline, sulphate of quinia, cinchona. 

No application to breasts equal to the belladonna ; if the 
plaster does not produce the necessary anaesthesia, put on the 
chloroform, aconite, and belladonna liniment; the chloroform 
will carry the belladonna down to the deepest nerve. There 
should be proper support, but no pressure. The uterine trouble 
should be seen to, and removed, according to its cause. 

Young infants, boys, and girls about puberty, are liable to 
slight neuralgia of the breasts. In some cases there are enlarge- 
ment, tenderness, and secretion of milk. There must be no irri- 
tating applications applied, no friction, nor any stimulating 
application, the belladonna plaster being usually sufficient. 

AGALACTIA, OR DIMINISHED SECRETION OF MILK. 

A diminished secretion, or complete absence of milk in nurs- 
ing women may be due to a variety of causes, as general weak- 
ness of constitution ; mental shock, or long-continued worriment ; 
exhausting disease; general plethora; acute or chronic disease 
of the nipples; torpor or inertia of the mammae; return of men- 
struation while nursing; approach of change of life ; improper 
use of drugs, chloral, opium, belladonna, iodine ; meagre or 
insufficient food ; over-work, or enervation ; careless nursing, in 
not permitting child to empty breast ; sexual excesses ; modern 
literature ; demoralizing influences. 

From among these and other causes, torpor or inertia of the 
breast is the most common variety. Two months before parturi- 
tion the intending mother should be requested to take, once or 
twice a week, enough of castor oil to move bowels gently, and 
as soon as she has recovered from the shock of parturition, a 
full dose. The child at the same time should be permitted to 
take nipple in its mouth ; if the latter is flat, or not sufficiently 
elongated, it should be gently drawn out by the mouth of an 
attendant, in this way the secretion is solicited. Castor oil, of 



DISEASES OF THE BREAST. 591 

all remedies, is the best for exciting the secretion, and the 
infant's mouth a natural stimulant. The breast in all cases is 
to be covered with flannel and kept warm ; mother should take 
hot drinks, oatmeal gruel, linseed tea; if still tardy in coming, 
hot poultice of boiled and bruised red carrots, in which castor 
oil is freely incorporated, should be applied to breast, and re- 
peated. Diet, if there is no uterine inflammation, should at 
once be generous : beef, mutton, game, poultry, white-fish oat- 
meal mush, potatoes, parsnips, carrots, all tend to favor secre- 
tion. Next to castor oil, internally, and locally to breast, ranks 
calabar bean, fennel, and anise seed, oils or waters. There is 
little use in electricity. The tincture of calabar bean, in fifteen 
to thirty drops in water thrice daily, or five to ten drops of either 
of the two oils on a little sugar. Any cause that can be detected 
should be removed. 

Defective lactation is not common when the mother is healthy, 
but among the weak and delicate it is very common. 

When it arises from over-feeding, over-stimulation, late hours, 
excesses, there is a true torpor of the breast; as a rule, it is best 
cured by purgatives, the most efficient being castor oil. Beer, 
wine, whisky, should be rigidly forbidden to all nursing ladies, 
as they cause swill-milk, and are destructive to the growth of 
child. Diet should be restricted, and causes removed. 

Defective lactation from anaemia and kindred states is the most 
common. It is to be overcome by a generous diet of animal food, 
fish, oatmeal, potatoes, carrots, parsnips, milk, eggs, and extract 
of malt, and using milk instead of tea or coffee. As nearly all 
our malt extracts are worthless, a pint of old Bass's ale can be 
substituted, which is a pure, unadulterated extract ; a half-pint 
in the forenoon and the same in the afternoon, and while taking 
it a tender-loin beefstsak, with bread, butter, etc., to constitute 
luncheon. This is not to interfere with the regular three meals 
a day. All food and drink should be warm. If the case is an 
extreme one, raw eggs several times a day, and cream to the 
oatmeal porridge. Avoid drugs if possible. If the appetite is 
faulty, port wine and cinchona before meals. 

Defective lactation is often due to sore nipples, or rather to the 
inability of the mother to permit babe to empty the breast. The 
germs of aphthae, which are abundant, must be destroyed and 
healed up as quickly as possible. 

Defective lactation from the use of drugs. — It is a most repre- 
hensible practice to administer drugs, as iodide or bromide of 
potass; acro-narcotics, as belladonna, morphia, chloral hydrate, 
alkalies, and other drugs, to nursing ladies, — drugs that dry 
up, wither, and atrophy the nerves of the gland. 

Defective lactation, due to a premature return of menses, should 
be treated by rest, freedom from excitement .and cinchona, port 



592 DISEASES OF THE BREAST. 

wine. Ladies, while nursing, should never menstruate, not until 
the infant is about fifteen months old. Over-work, fatigue, and 
other causes, should be seen to. As a rule, sexual congress 
is unfavorable tor a secretion of milk. 

Galactorrhoea, or Excessive Secretion of Milk. — A super-abundant 
secretion of milk in nursing women, owing to which excess the 
milk keeps continually oozing away, sometimes in large quanti- 
ties, keeping the patient's clothing wet, besides being a heavy 
drain upon the system ; from which anaemia, hysteria, dyspepsia, 
tuberculosis often arise ; as a rule, milk is poor in quality. 

To diminish the secretion, same diet as in defective lactation, 
but an avoidance of the malt extract. We have some valuable 
remedies to diminish or arrest secretion : the application of 
belladonna, either in extract, plaster, or ointment, to the breast, 
will cause an instant arrest of secretion, by temporarily paralyz- 
ing the nerves of the mammae, upon which secretion depends. 
The use of the drug internally has the same effect, but not in 
such a marked degree. All acro-narcotics, as stramonium, 
hyosciamus, have the same property, but not in such a striking 
degree as the belladonna ; that is sure, and with it the physician 
can either diminish or arrest the secretion of milk at will. 

The iodide of potass is peculiarly useful ; and the local appli- 
cation of the nitrate of potassa and vinegar to the breast is not 
to be overlooked, especially if inflammatory symptoms, as ten- 
sion, swelling, exist ; bowels at same time being opened with 
salines. The application of warm vinegar, in which nitrate of 
potassa is dissolved, has a good action in arresting the secretion, 
but it is very withering to the secretory function of the gland ; 
it. is best applied by wringing flannel cloths out of the mixture, 
and changing frequently. 

Lobelia, in ointment form, acts like belladonna, but is slow 
and nauseating. Camphor and conium in pill form is very use- 
ful : and camphor dissolved in melted lard, and applied to the 
entire breast, is not to be overlooked. Sage, hyssop, catnip teas 
are popular remedies and can do no harm. 

HYPERTROPHY OF THE BREAST. 

Enormous enlargement of the breast is often met with in both 
single and married women ; sometimes one gland, in other cases 
both glands slowly increase in size. It is not attended by 
inflammatory symptoms ; no heat, pain, induration — nothing 
but progressive enlargement, which becomes burdensome and 
unsightly. The affected glands may point right out, but more 
generally they hang, loose, flabby, and pendulous, reaching, in 
some cases, well to the navel or knee. 

Causes. — Rather obscure ; in some cases we can see its con- 
nection with goitre ; in another class with masturbation ; while 



DISEASES OF THE BREAST. 593 

in still another, uterine and ovarian irritation, chiefly from 
imperfect sexual intercourse ; impaired health, etc. 

Treatment. — Alteratives and tonics ; every possible means 
to improve the general health and activity of the uterine organs 
should be resorted to. As a rule, however, all means are very 
unsatisfactory and unavailing. Amputation of breasts is most 
invariably followed by tetanus. 

TUMORS OF THE BREAST. 

The female breast may be the seat of a variety of tumors. 
Some are simple, and devoid of pain and lymphatic engorgement, 
and composed of the normal elements of the body ; others are 
malignant, or consist of a mass or aggregation of disease-germs, 
— the degraded bioplasm of their own bodies, — which are always 
painful, and attended with lymphatic engorgement in two-thirds 
of all cases. The implication of the lymph-channels has an 
important bearing on both kinds of growths. 

(1.) Lacteal Tumor. — Milk tumors are generally due to 
violence or blows, which cause a rupture of a lacteal tube, which 
permits of the escape of the milk into the surrounding connect- 
ive tissue; or it may take place from an occlusion of the orifice 
of a milk-duct, by inflammation of the nipple, and various other 
mechanical conditions. It occurs only during the activity of 
gland in lactation. 

Symptoms. — A round, oval, or cystic swelling, varying in 
size from a walnut to that of a large orange or pear, can be felt, 
which, when recent, is elastic and fluctuating, but as its watery 
portion becomes absorbed, it becomes firm and solid. There is 
an absence of pain, and the general health is unaffected. So 
very little annoyance does it give rise to, that the patient may 
not discern the enlargement for quite a while, or by accident, 
and wmen she does so becomes greatly alarmed, fearing cancer. 
If the patient is tubercular, the coagulated caseine in tha lobule, 
or in connective tissue, sometimes becomes a concretion, like 
chalk. 

Treatment. — If infant is old enough, or not near the approach, 
or during the summer heat, wean the child; arrest secretion of 
milk by belladonna; administer saline purgatives ; and subse- 
quently apply ozonized clay to the breast, and place patient 
upon an active course of alteratives, as compound phytolacca 
ozonized, iodide in stillingia compound, glycerite of ozone. If 
there is suppuration, incision and same treatment as for abscess. 
As a rule, there should be no interference with the coagulation 
until gland-tissue becomes inactive. 

(2.) Fatty Tumor. — Masses of fat may be freely and evenly 
distributed throughout the entire connective tissue of the gland, 
or in nodules, or aggregation at different points. Its doughy, 

50 



594 DISEASES OF THE BREAST. 

inelastic feel and perfect freedom from pain will be good points 
by which to recognize it. They grow slowly, give rise to immense 
bulk and considerable inconvenience. 

Treatment. — Ozonized clay is the only known remedy that 
will cause a dissolution of those growths. Kept on the breast 
or tumor constantly, if no redness of skin is produced ; if redness 
is caused, to be removed, and lotions of borax applied, and then 
the clay reapplied again and again. Interally, alteratives, as 
in lacteal tumor. 

(3.) Fibrous Tumor. — Fibrous tissue may be effused in a 
nodule, or mass, in the breast, constituting a tumor of irregular 
shape, hard, dense and fibrous ; it may become large. No pain 
or lymphatic enlargement. General health good. In some cases 
they assume a cartilaginous or bony consistency. They, as well 
as the fatty, depend, the one upon an excess of adipose tissue, 
and the other upon a super-abundance of fibrous tissue in the 
blood, owing to some constitutional defect. 

Treatment. — If not very dense or hard, the same treatment 
as for the fatty; but here alteratives as compound phytolacca, 
iodide of potass, glycerite of ozone, play a most important 
part in procuring their absorption. So those remedies should 
be persevered with, and the clay kept on, alternately with bella- 
donna, iodide of potass and muriate of ammonia. Even in 
cases as dense as bone, they can often be absorbed with the 
above remedies. Never tamper with electricity or irritants. 

(4.) Hydatid Cysts. — These cysts, containing the larvae of 
the taenia echinococcus are often met with in the female breast. 
The echinococcus are usually found in the fluid contents of 
the sac. 

They should be treated by a free incision and removal of all 
the cysts, especially the parent one. Nothing but their extir- 
pation suffices. 

(5.) Glandular Tumor. — Irritation of various kinds, as 
corset bones, dress ; mechanical violence, as blows, contusions, 
etc., often cause a sort of glandular growth in the interstitial 
structure of the breast. In one variety of partial hypertrophy 
of gland structure we find the tumor dense, compact, lobulated 
and provided with a fibrous capsule ; with ducts and sinuses 
developed. In another class, there are cysts with growths at- 
tached to their walls and floating in a fluid ; while, in still 
another class, dilated ducts are converted into cysts, with 
growth of gland springing from their sides. 

These glandular tumors, made up of the substance or out- 
growths of the breasts, occur in healthy women, between puberty 
and the thirtieth year of age ; and single women are much more 
liable to them than the married. Their growth is slow, pro- 
gressive, and an enormous size may be attained. In some 



DISEASES OF THE BREAST. 595 

cases they grow considerable, then cease, and often disappear ; 
in other cases, after growing to a certain size, they remain 
stationary and breasts disappear. There is never pain nor 
lymphatic enlargement. 

Symptoms. — The tumor begins as a small, movable growth 
— seems to be isolated from gland tissue — never painful ; nor does 
it involve the skin nor cause enlargement of the lymphatics of 
the axillary space. As it grows breast may atrophy. Rate of 
growth depends on irritation. If it becomes very large the 
coverings might ulcerate, and the tumor protrude through. 

Treatment. — The application of the ozonized clay during 
the day, and the belladonna ointment during the night, with 
a general vegetable alterative and tonic course, is the best 
treatment. 

(6.) Mucous Cysts consist of dilated and expanded gland 
ducts filled with mucus and epithelium. There may be one, 
or several cysts, in one or both breasts. They seldom grow 
larger than a hazel-nut. Most common after change of life. 
They give rise to no pain or inconvenience, but when detected 
should be removed by a simple incision. If allowed to remain 
they simply become the seat of cancerous deposits. 

(7.) Cancerous Tumors. — The aggregation of cancer-germs 
into the breast may be in the form of scirrhus, medullary or 
colloid — scirrhus or chronic form being the most common, and 
the age of frequent development between forty and fifty. The 
tendency of this germ, if not properly cared for, is to increase 
by cell-growth and form fresh deposits from the blood. After 
having used up in its own nutrition and growth the breast, 
and usurped its structure, it has a tendency to ulcerate, give 
rise to great pain, and engorgement of the lymphatics in axilla 
and below the collar-bone. 

Pain is characteristic of this malignant tumor ; it need not 
be a constant pain. If there are simply a few germs the pain 
may resemble a needle darting through it ; if there are a large 
colony of germs, like a knife and frequent. Besides the en- 
largement of lymphatics, the retraction of the nipple, protru- 
sion of the tumor, and its fixation to the walls of the chest 
are indubitable signs. There may also be a discharge from 
the nipple, but that simply tells us that the glandular structure 
is involved, and one or more ducts leading to the secreting 
lobules are permeable. Besides, there are likely to be the can- 
cerous cachexia. The duration of scirrhus is less than four 
years from commencement ; of medullary, less than eighteen 
months. Scirrhus is hard, lobulated ; medullary soft, doughy; 
in the former pain much less than in the latter. 

Treatment. — If the lymphatics in the armpit are no larger 
than an ordinary kidney-bean, the best of hopes may be enter- 



596 DISEASES OF THE BREAST. 

tained of a cure ; if larger, all that may be possible is to retard, 
or keep disease stationary for a number of years. After putting 
patient upon the ozonized phytolacca for a few weeks the plan 
of proceeding with the tumor can be decided on. If it begins 
to grow less under that remedy, and pain leaves, then there is 
usually no need to remove it. The ozonized clay can be ap- 
plied occasionally, and after its removal belladonna. The ap- 
petite, the bowels, skin, kidneys being attended to, and the 
best of diet given, so as to make new blood rapidly, and slowly 
and progressively the cancer disappears. In that case keep up 
the phytolacca for six months after its disappearance. If it is 
decided to remove it then cover the breast with adhesive 
plaster, all but what will be a sufficient opening for the cancer 
to drop out. Over this window apply the paste chloride of 
chromium ozonized. Apply about half an inch thick ; keep it 
on till it dries, then apply again in the same manner, and 
again, say every day. This remedy causes no pain, penetrates 
down to the deepest root of the cancer, unites with it, and de- 
stroys every vestige of it. It becomes a dead mass ; then re- 
move the chromium plasters, and poultice the breast every three 
hours with linseed poultices, and continue until it drops out. 
In some cases this may be a few days, weeks, or even longer. 
If every root be not destroyed a little of the paste can be ap- 
plied. When it drops out dress with ozone ointment ; don't 
be in a great hurry to heal it up. At, the same time push the 
internal remedy, and prolong sleep to ten or twelve hours 
daily, with conium and hyoscyamus, and see to the food — beef, 
mutton, poultry, eggs, white-fish, oatmeal porridge and cream, 
fruits, vegetables. 

During the healing process the sore or cavity should be 
washed out with a solution of sulphate of manganese, or per- 
manganate of potass, and kept well strapped with adhesive 
strips and supports. Either flannel or silk is best next the 
gland. This is the most successful, least painful, and saves 
more lives than all other forms of treatment. The living 
monuments of its great efficacy are scattered over the entire 
union, in a perfect recovery from this terribly fatal disease. 

The very nature of cancer, being a disease-germ from and 
in the human blood, precludes all hope of cure from an opera- 
tion with the knife, so much so, that all scientific surgeons have 
now discarded that. It can be removed as freely, completely, 
and successfully with the plaster. Most successful before the 
adjacent lymphatics become implicated or involved. 

The mode of applying the plaster involves no new principle, 
no complex proceedure. The absence of palpable enlargement 
of the lymphatics affords us the best hopes of a cure. 



DISEASES OF THE EYE AND EAR. 597 



DISEASES OF THE EYE AND EAR. 



VARIATIONS IN SIGHT. 

Although the Caucasian was the last of the races created, he 
is the most perfect in Divine mechanism — his brains the rich- 
est in cineritious matter and in convolutions of thought Al- 
though he possesses this superiority and is the only civilizing 
race — the race that possesses the attributes of invention and 
progress in sciences and arts, still, withal, his senses are far 
inferior to woman's, and to other lower, inferior and distinct 
races. The senses of smell, hearing and seeing are more acute 
and powerful in the Negro, Indo-American, Mongolian, etc., 
than in the white race. 

Vision, or sight, is performed by the brain through a per- 
fect optical apparatus, the eye, by or through which the brain 
looks at the exterior world. There are variations in vision. 
In order to arrive at a proper conclusion as to a deviation, a 
normal standard must first be laid down. 

(1.) Emmetropia. or normal vision, or sightedness, in a 
Caucasian male between fifteen and forty-five years of age, 
with a healthy brain and eye, he can distinguish an object the 
six hundredth part of an inch in size, at a distance of six inches. 

The power of vision is often injured by the use of eye-glasses. 
Conservative spectacles of blue and other colors, worn at sea- 
shore in summer months are destructive to vision; always 
injure more or less, as the retina is only benefited by a white 
light. 

(2.) Myopia. — Short or near-sightedness, may be said to 
exist when the distance at which ordinary type can be read is 
less than twelve inches, and when near objects can be seen 
distinctly. Bright light aggravates the condition. 

Myopia may be hereditary, transmitted by either or both 
parents to the child or children, and in such cases there is 
usually too great a convexity of the cornea, or crystalline lens, 
or both. It may also be due to lengthening of the eyeball ; 
to an undue density of its refractive media. The rays of light 
from objects at usual distance are brought to a focus before 
reaching the retina, instead of being concentrated upon it. 
Overcrowding in public schools, with a low grade of purulent 
ophthalmia produces grave changes on the eye, and causes a 



598 DISEASES OF THE EYE AND EAR. 

large number of children to become myopic. The percentage 
of myopia in our large schools is immense compared with small 
classes in distinct buildings far apart. It is not due to want of 
light or ventilation, but the mass of children crowded together, 
and perhaps, aided by an insufficient amount of brain-food to 
the child, and, in some cases, by the rather great and ever- 
increasing demands upon the little one's industry at home ; 
forcing prolonged labor on their eyes during the evening hours, 
frequently by artificial light. We must never underrate the 
insanitary condition of overcrowding, while the children's eyes 
should be spared the fatigue of evening work. We cannot ignore 
the fact that our large schools are manufacturing a race of short- 
sighted people far greater in number than what is inherited or 
produced by other causes. It is often a fashionable complaint, 
affecting those who read much and think little ; but ultimately 
it becomes confirmed. It may not increase with age. The con- 
traction of the iris in the nervous temperament often gives rise 
to it. Indulging children by permitting a light in the room 
while asleep deprives the eye of its natural rest in darkness and 
is productive of myopia. Overwork, strain, looking at small 
objects, reading by gas-light, oil -lamps, etc., are causes. Snow 
blindness is due to excessive contraction of the pupil. 

(3.) Presbyopia. — Long-sightedness ; an alteration in the re- 
fractive power of eyes, producing presbyopia. It is an indication 
of atrophy of brain, or of approaching old age ; seldom begins 
before forty-five years of age ; often a precursor of glaucoma. 
Vision is imperfect for near objects; distant ones seen clearly. 
There is always associated with it more or less weakness of sight. 

(4.) Asthenopia. — Weak-sightedness, from fatigue of mus- 
cular system of accommodation. Eyes weak, but appear nor- 
mal ; inability to read or write for any length of time ; letters 
become indistinct and run into each other ; eyes weak or get 
very tired. There is muscse volitantes, headache. If unrelieved, 
eyes will become useless for work. Rest, sea air, food, tonics, 
a perfect suspension of work. 

(5.) Astigmatism. — An inequality of the refractive power 
of the several meridians of the eye. Convexity of the cornea 
from above downwards, or from side to side, a common cause. 
It is often considerable, and interferes with the sharpness of 
sight. 

(6.) Color-Blindness. — An inability to discriminate between 
certain colors, is a condition that seems to be coming more com- 
mon, and is of especial interest to the general public as regards 
an avoidance of accident by excluding affected persons from 
the offices of engine-drivers, signalmen, pilots ; and it is fortu- 
nate the class of individuals affected rarely seek such employ- 
ment. Quakers are much affected with it, so are Jews. In the 



DISEASES OF THE EYE AND EAR. 599 

former it is brought about by a marked characteristic, a general 
coalescence of the typical fissures of the brain, induced by monot- 
ony, sameness, isolation ; a condition often present in insanity, 
epilepsy and other low types of the human brain ; in the latter 
class relationship or'consanguinity, wipes out the mental char- 
acteristics and obliterates the convolutions. This in-and-in 
breeding, as well as solitariness predisposes to suicidal mania 
and causes color blindness. 

The average per cent, of color-blindness among any given 
people will depend upon the preponderance among them of 
Friends and Jews, or persons who possess the same chacteristics. 
It always diminishes as we ascend the social or educational 
scale. Among deaf mutes the percentage is even greater than 
the two classes mentioned. Intermarriage is not only a great 
factor, but the same law extends to temperment and races. 
Intermarriage not only creates the defect, but aggravates it, 
causing the most intractable form, which is red blindness. 
There is also to be found an unusually high average of color 
defects among the children of either fathers or mothers who 
work among colors. Trades requiring great concentration of 
sight, as engraving and watchmaking, seem to bring it about. 
Women are equally affected with men. The average percentage 
in people of low civilization or culture is great ; among deaf 
mutes, ten per cent., and among Friends and Jews, about six 
per cent. 

Color-blindness is a defect which is quite compatible with 
perfect vision in other respects. Color-blindness is found to exist 
in three forms: 

(1.) Inability to distinguish any color, properly so called — 
black or white, or light and shade. 

(2.) Inability to distinguish between nicer shades of more 
composite colors, as brown, gray, and neutral tints. 

(3.) Inability to distinguish between primary colors — red, 
blue, yellow ; or secondary and tertiary colors, as green, purple, 
orange. 

In the latter form there is a defective appreciation of all colors. 
Little good results from any treatment; and as there is about 
one per cent, of the entire population affected, care should be 
exercised by railroad officials, pilot boards, etc., that no affected 
person be employed, so as to avoid serious accidents. 

(7.) Hypermetropia. — Oversight; a condition in which the 
refractive power of the eye is too low, or the optic axis too short ; 
consequently when the eye is in a state of rest, parallel rays are 
not united upon the retina, but behind it, and only convergent 
rays are brought to a focus upon the latter. Distant objects are 
not seen clearly; eyes look smaller and flatter than in health ; 
very apt to be headache, or dull pain in eyes, with heat and 



600 DISEASES OF THE EYE AND EAR. 

fullness ; in reading, words run into each other. It causes weak 
sight, squinting, and blindness. 

(8.) Amblyopia. — Weakness of sight from disease of brain, 
optic nerve, or of retinal expansion of optic nerve ; often caused 
by the use of drugs. Women, in order to impart an unusual 
brilliancy to eyes, take morphia and other drugs, which often 
cause this defect. It is also brought about by chloral, which 
exhausts the ophthalmic tract. There is a form of this, which 
is very common, called central amblyopia, in which direct vision 
is alone impaired, whilst that of the peripheral portion of the 
retina is unaffected, or but slightly less acute than normal. This 
kind or group constitutes a class of cases, which, from their fre- 
quency and rapid recovery, when the cause is removed, are 
highly interesting; they rarely terminate in total blindness. 
Central amblyopia is most invariably due to tobacco, and in 
more rare cases, to alcohol, chloral, morphia. The deleterious 
action of tobacco upon the base of brain and on the optic nerve 
has long been known in causing paralysis, not only impairing 
vision, but causing a vacancy, dullness, restlessness, and wild- 
ness of the eye. 

Besides tobacco, the very general use of lead, nitrate of silver, 
and pyrogallic acid, in hair dyes, lotions for hair; bismuth for 
cosmetics, and other trash in blooms of youth, etc., all gravi- 
tate to the base of brain, and cause this form of imperfect vision. 

(9.) Diplopia. — Double vision arises from some derangement 
of the visual axis by paralysis or spasm of the muscles of the 
eyeball, or in some irregularity of density, or curvature of diop- 
tric media, or some disease of the optic nerve or brain. It is often 
caused by the prolonged and indiscriminate use of gelsemium 
in spermatorrhoea. 

(10.) Hemiopia. — Faulty vision; half an object only seen. It 
may be temporary or permanent. 

(11.) Hemeralopia. — Night-blindness or day-vision : that con- 
dition in which vision is only good or distinct during the day- 
light. Travellers, soldiers, sailors, in the tropics, by long exposure 
to brilliant or intense sunlight, or to the reflection of the sun's 
rays on white sand in the desert, exhaust the sensibility of the 
retina, so that its delicate structure ceases to be affected by twi- 
light. It may be a symptom of scurvy, or caused by action of 
moon. The affected individual is incapacitated for all duty after 
sunset. This excessive weakness of the retina, which causes 
night-blindness, is also the result of sexual excesses and mas- 
turbation; then organic changes in brain and optic nerve are to 
be feared, and total blindness follows, which is irremediable. 

(12.) Nyctalopia. — That condition in which vision is most 
powerful or acute during twilight. 

(13.) Photophobia. — Intolerance of light is a constant symp- 



DISEASES OF THE EYE AND EAR. 601 

torn in all inflammatory affections of the eye and brain. Dark- 
ness; fomentations, stimulants to nape of neck, origin of optic, 
with active bowels and skin, are always salutary. 

(14.) Nydriasis. — A dilated condition of pupil, present in 
bloodless states of brain, gives rise to imperfect vision. It may 
also be due to paralysis, induced by belladonna, use of tobacco, 
and other acro-narcotics, which cause the iris to lose its power 
and remain dilated. 

(15.) Myosis. — A contracted pupil, present in congestion of 
brain ; seldom due to drugs, unless chloral hydrate or calabar 
bean be given. Watchmakers, engravers, who look at minute 
objects, are affected. It gives rise to great obscurity of vision in 
a weak light. 

(16.) Muscae Volitantes. — When the vital integrity of the 
brain is lowered or depressed, and either anaemia or hyperemia 
is present, the nerve filaments that supply the aqueous humor 
and vessels of choroid are relaxed. If the debility be great, 
vessels take on varicosity ; and when the brain looks through the 
eye at the external world, it sees the varicose vessels, tortuous, 
and anastomosing in every conceivable form, and it then com- 
pares them with objects seen or described in the external world ; 
if depression be not very great they will be compared to small 
objects, as flies, specks, spots ; if depression be great, the vessels 
are greatly engorged ; then the patient will compare them to 
large objects, as men, devils ; they are real, no hallucination, as 
the patient sees them in his own eye. It indicates brain exhaust- 
ion, in a mild or aggravated form. 

(17.) Protuberant Eyeballs, so large that the eyelids cannot 
close on them, may be due to wasting, to anaemia. The reflex 
action of masturbation, in both sexes, has a remarkable effect 
in its production ; more common in ladies than in men. It is 
a symptom of phthisis in all its varied forms. 

DISEASES OF THE EYELIDS. 

(1.) Styes. — Hordeolum, or stye, so called from its fancied 
resemblance to a grain of barley, is identical in its origin, symp- 
toms, and the bacterial nature of its contents, as a boil; mal- 
assimilation being the cause, and the degraded living matter, or 
micro-organism present being bacteria. 

Treatment. — Same as for boils, by an emetic ; rouse up liver 
with podophyllin pill ; an alcoholic vapor bath. If the effused 
lymph and bacteria in follicle have not broke, try painting it 
with tincture of iodine and iodide of potass, or extract of bella- 
donna ; internally, antiseptics. (See Boils.) 

(2.) Ophthalmia Tarsi. — Inflammation of the roots of the 
eyelashes, meibomian glands, and edges of the lids, with effusion 
of serum, lymph, pus, which forms minute pustules at the roots of 



602 DISEASES OP THE EYE AND EAR. 

the eyelashes ; those pustules, coalescing and breaking, form 
crusts, scabs, matting the hairs and uniting the eyelashes during 



Causes. — Impaired health, tubercular diathesis, perverted 
state of nutrition, or mal-assimilation, give rise to the degra- 
dation of bioplasm, micro-organism, bacteria ; hence the disease 
is contagious and infectious, especially by towels, or other close 
contact. In some cases the cryptogam or its spores may lodge 
in the part, and thus give rise to itching and irritation. 

Symptoms. — Usually a chronic affection; but in some cases 
considerable pain and soreness, itching, gluing of the lids; 
destruction of the matrix of the hairs, or tarsi, so that the eye- 
lashes are destroyed, leaving a blending of the skin and con- 
junctiva into a red, shining cicatrix; when severe or extensive, 
causes obliteration of the puncta lachrymalis; then secretion of 
tears runs over on cheek. 

Treatment. — The condition of stomach and bowels merits 
close attention : Emetics ; occasionally remedies to stimulate liver 
and skin ; flannel clothing; best of diet, animal food, milk, eggs ; 
change of air and scene ; a general alterative course, iodide of 
potass in compound extract of phytolacca, saxifraga, or stil- 
lingia ; glycerite of ozone ; tonics before meals, as cinchona and 
mineral acids, sulphate of quinine, and aromatic sulphuric acid. 

Locally, wash eyes several times daily, and at night smear 
edges of lids freely with vaseline or ozone ointment. Painting 
edges of lids with aromatic sulphuric acid operates like a charm ; 
it may be either diluted or applied in full strength. In all cases 
push best of nourishment ; alteratives and tonics ; and use only 
antiseptic drugs about eye ; poultices to be avoided ; better to 
soften and remove crusts with hot fomentations, or warm milk, 
which is a powerful attractor of germs. 

(3.) Trichiasis. — An irregular direction of one or more of the 
eyelashes, when the cilia or hairs present their points towards 
the globe of the eye, causing chronic inflammation of thecon- 
junctiva. 

Treatment. — Misdirected hairs to be extracted singly with 
forceps ; the hair follicle to be destroyed by dabbing with alco- 
hol, or touching with stick of nitrate of silver. 

(4.) Ectropion. — Eversion of the eyelid may be due to long- 
continued ophthalmia, or to contraction of one or more cicatrices 
on the cheek, or to dropping of the lower lid from paralysis ; 
more common in lower lid than in the upper. 

(5.) Entropion. — An inversion of the margin of the eyelids. 
It may result from a cicatrix in conjunctiva, neglected purulent 
ophthalmia. If the eyelashes are in the way they should be 
removed. Cases of ectropion and entropion can often be man- 
aged without operation, by the judicious application of collodion 



DISEASES OF THE EYE AND EAR. 603 

and tannic acid ; by the application of pulverized alum and 
white of egg. 

(6.) Epiphora. — A superabundant secretion of tears, so that 
they run over on the cheek. Very common in tubercular chil- 
dren, and in adults with a highly developed sympathetic. It 
may also be due to irritation, foreign bodies. It has no relation 
to closure of the puncta lachrymalis. Alteratives and tonics. 

(7.) Ptosis. — A dropping of the upper lid, or an inability to 
lift it, owing to palsy of the third nerve. It is a very common 
symptom in apoplexy and cerebral disease ; in rare cases, due to 
debility. 

OPHTHALMIA. 

Inflammation of the mucous membrane of the eyelids and of 
the eye is one of the most common of all forms of disease of the 
eye. There are several varieties. The cause in all cases is irri- 
tation from cold, light ; discharges containing micro-organisms. 
They are all contagious or infectious, and have the following 
symptoms in common : intolerance of light ; a sensation of sand 
in the eye ; a muco-purulent discharge, loaded with bacteria and 
other germs. 

(1.) Infantile Ophthalmia. — So called because it takes place 
in infants from two to four days after birth, beginning at edges 
of the lids and proceeding over entire conjunctiva. 

Causes. — The child, in its passage from the uterus, may have 
its eyes inoculated with leucorrhceal or gonorrhceal matter, or 
other discharge from the mother's genital organs ; or, by inad- 
vertence of nurse, some of the sebaceous secretion on the body 
of the child may have got into the eyes ; or irritating soap, or 
cold, or light. 

Symptoms. — A spasmodic closure of lids ; lashes stick to- 
gether ; hard crusts form at the edge of lids, which are red ; the 
redness and swelling increase, lids more swollen ; the conjunc- 
tival sac becomes filled with a transparent, yellowish-colored 
serum and mucus ; engorgement continues ; then pus, or thick 
muco-purulent matter makes its appearance; the tumefaction 
of the conjunctiva is so great that the lids will scarcely close, 
and the discharge so copious that it runs down the cheek of the 
infant ; the cornea of the eye looks depressed, or retracted, or 
hid ; the surrounding conjunctiva fleshy and elevated, owing to 
its infiltration with red blood, serum, etc. This swollen condition 
of the conjunctiva, looking elevated, while the cornea looks 
depressed, is called chemosis. As the discharge is so loaded with 
bacteria and other diseased germs, if great care is not observed 
it may contaminate the other eye, or that of nurse or mother. 
If not actively seen to, the symptoms will increase in severity. 
The mucous membrane of the conjunctiva possesses a lamellated 



604 DISEASES OF THE EYE AND EAR. 

epithelium, and has the faculty , when so inoculated, of a prolifer- 
ation of its epithelium, which is transformed into pus cells, which 
process of shedding gives rise to an enormous discharge, and a 
continual thinning or peeling of the conjunctiva of the ball of 
the eye, which becomes soft, and liquefies, and ulcerates, and 
contents of eye are liable to escape. Perforation is very liable 
to happen if allowed to run two or three weeks, especially if the 
lids are swollen and tight on ball. Should the eye escape disor- 
ganization, there is often opacity of the cornea left behind, or an 
opacity of lens, or some defect in vision. The greatest care is 
necessary in opening the eye ; it must be done with great caution 
and care. 

Treatment. — Bowels to be opened freely with cascara or oil ; 
fever to be controlled with aconite and sweet spirits of nitre ; 
bathing night and morning ; room darkened ; one-eighth or 
one fourth of a grain of quinine taken thrice daily, in syrup, as 
this is the great tonic to the eye. Locally, the child upon your 
lap, wash the outside of eye carefully with the following mix- 
ture : ten grains of borax ; one ounce of rose-water ; six ounces 
of plain water. Mix, and warm sufficiently to wash out the eye 
carefully. After washing out, drop in a few drops of a solution 
atropia : Sulphate of atropia, one grain ; water, two drachms ; 
glycerine, one drachm ; mix. Three times a day. This atro- 
pine has an antiphlogistic effect on the inflamed surface, dilates 
the pupil and relieves the tension of the eyeball. Never use 
cold applications nor ointments, unless it be vaseline or ozone 
ointment, to keep lashes from sticking together. Warm sweet 
milk is the best agent for washing or fomenting. In more 
aggravated cases, a lotion of aromatic sulphuric acid instead of 
the borax. The other eye to be carefully guarded. 

(2.) Common Acute Ophthalmia. — Or catarrhal ophthal- 
mia is a mild form of inflammation of the conjunctiva and mei- 
bomian glands. Its common causes are cold, wet, sudden 
changes of temperature, sand, foriegn bodies, etc. Contagious 
and infectious. 

Symptoms. — Intolerence of light, pain in the eye, a sense of 
soreness or scalding, stiffness, dryness, a feeling of roughness 
about the eye, as if there was sand in the eye. This sensation 
is caused by the congested condition of the vessels of the lid 
and globe. They are tortuous, swollen ; red blood circulating 
where only white blood was wont to circulate; roughened, 
and by rubbing over each other, carry this sensation to the 
mind. These vessels can be seen ; of a light scarlet color and 
irregularly arranged, and can even be moved by the finger. In 
bad cases general congestion. The discharge is puriform at 
first, and then becomes muco-purulent. In some cases head- 
ache, rigors, fever. 



DISEASES OF THE EYE AND EAR. 605 

Treatment. — Active treatment same as is laid down under 
purulent ophthalmia. 

(3.) Purulent Ophthalmia. — A severe and dangerous form 
of ophthalmia; more contageous and infectious than the former. 

Causes. — Overcrowding of large bodies of men, women and 
children together in shops, jails, cities schools and other insti- 
tutions. The miasma of each other's bodies is supposed to 
degrade the normal bioplasm of the conjunctiva into the micro- 
organism, the bacteria ; hence a virulent form of disease. Where- 
ever and whenever the condition of overcrowding exists, this 
diseased germ appears. The vitality of this bioplasm is great, 
and still greater when growing and multiplying in the mucous 
membrane of the eye. The living particles are so vital that they 
can be preserved in clothes for years; can be carried great 
distances in the air. A school, a refuge, jail, or ship, once infected 
with such particles, months, and even years, may be necessary 
before the disease-producing germs can be got rid of. 

Symptoms. — All the symptoms are well defined : the sore- 
ness or redness ; the intolerance of light ; the sensation of sand ; 
the copious or profuse muco-purulent discharge, with other 
severe symptoms, intense, with prostration, rigors, and violent 
fever ; the pain in head and eye agonizing; and the amount of 
discharge of thick, yellow, purulent matter immense. The con- 
junctiva of both lids and globes swell, so that it is with difficulty 
that the cornea and iris can be seen (chemosis) ; and the discharge 
flows on cheek. If disease does not yield to proper treatment, 
the inflammation will increase, spread to the cornea and deeper 
structures of the eye. When the internal textures become 
involved, constitutional symptoms are still more aggravated ; 
extensive sloughing takes place, and the sight, and often the eye, 
is lost. Sometimes one eye, in other cases two are affected simul- 
taneously. 

Treatment. — Patient to be kept in bed, in a well-ventilated, 
dark room ; antiseptics in apartment ; open bowels with podo- 
phyllin pill and enemata ; bathe the surface thrice daily ; vera- 
trum viride, aconite, and sweet spirits of nitre, so as to keep 
pulse at 70 ; hypodermic injections of pilocarpine, to keep up 
diaphoresis ; quinine, in doses ranging from one to five grains, 
every four hours ; and solution of sulphate of morphia, at bed- 
time, sufficient for sleep ; mustard to nape of neck, right over 
medulla as long as can be borne, followed by croton oil; then 
hot poultices every three hours, and, if necessary, repeat croton 
oil daily, so as to establish free suppuration at the nape of the 
neck — a space of four or five inches is sufficient. To the eye, 
wash out carefully with some antiseptic lotion, as borax, or per- 
manganate of potassa, or aromatic sulphuric sulphuric acid, or 
boro-glyceride ; use fomentations of the same ; inject the corners 



606 DISEASES OF THE EYE AND EAR. 

of lids, and cleanse out ; after it is performed drop in solution of 
atropia ; this should be done every two hours ; warm fomenta- 
tions of the above to the eye at all times. If case yields, hold 
on to the above plan for a few days, and if all goes well, iodide 
of potass in vegetable alteratives, with tonics, holding the patient 
chiefly on cinchona, glycerite of ozone, and kephaline. All 
through the case the diet to be most generous ; and if we bear 
in mind that we have a terribly destructive living poison to deal 
with, it will be the guide for hygiene. After patient is around, 
change of air, and irritating plaster to nape of neck for three 
months. 

In our present school system in our large cities, we find an 
immense amount of this type of ophthalmia in a low, chronic 
form, due to the congregating of large bodies of children together. 
Indeed, in all large schools it rages in a mild form ; but even in 
this type it is sadly productive of causing impaired vision in city 
children, so much so that our large schools will be abolished as 
soon as fathers and mothers can appreciate the difficulty. 

In such cases keep child at home, in a partially darkened 
room ; administer cinchona ; give good food ; daily bathing, and 
use vaseline to the eyes morning and night. 

(4.) Gonorrhceal Ophthalmia. — Persons suffering from gon- 
orrhoea sometimes inoculate their conjunctiva, by touching it 
with their fingers, or with a dirty towel, used by themselves or 
a fellow-boarder who has a running. Most frequently right eye 
that is affected. Women are rarely sufferers from it. 

Symptoms are the same as the purulent, but more contagious 
and infectious, as the discharge contains a venereal bacteria. 

Treatment must be very prompt; same as the purulent; 
increase dose of quinia, and nourish still better ; no good in any 
other treatment ; leeching is of no utility, being simply a zoologi- 
cal humbug. The great point is the destruction of the germs, 
and preservation of the eye. The treatment laid down is the 
only one that can save the eye from disorganization. 

(5.) Tubercular Ophthalmia. — An affection met with among 
children, from period of dentition up to about the tenth year of 
age. The tubercular cachexia is usually present in a high 
degree ; the skin white and thin ; muscles soft and flabby ; hair 
as dry as tow ; torpidity of all the great secreting organs. 

Symptoms. — There is no soreness or rawness, no sensation of 
sand in the eye, no muco-purulent discharge ; but the intole- 
rance of light is very great, with spasmodic contraction of the 
lids ; there is a copious lachrymal secretion ; irritability of the 
nasal and buccal mucous membrane ; fleshy redness is absent, 
but there is a very slight conjunctival and sclerotic redness, 
with formation of pustules or ulcers od cornea. Both eyes are 
usually affected. Hot tears profusely flowing over cheek cause 



DISEASES OF THE EYE AND EAR. 607 

an excoriation. There are often the thick lips, long eyebrows 
and eyelashes, eruption behind the ears, with disordered intesti- 
nal secretion, so often present in tuberculee. 

Treatment. — Eyes must be protected. with a green shade; 
and when not exercising for health in the open air, to lie down 
in a well-ventilated room, and a lotion or wash of common salt 
and water kept applied. The strength of this wash will depend 
on the age ; it must be strong enough so as to barely feel it, not 
to cause the least smarting. It is the best of all local applica- 
tions. This wash is to be kept on as much as possible, and 
changed every little while, as it becomes dry; and cloths either 
washed or destroyed ; never allow it to become dry; an emetic 
twice a week for six weeks, of wine of lobelia ; encourage child 
to drink freely some tepid water with bicarbonate of potassa, and 
then follow with half teaspoonfulls of the wine every five min- 
utes till free vomiting takes place. The effect of this emetic on 
the eye is really wonderful ; it acts like a charm ; benefits at 
once, and the whole aspect of the disease changes for the better. 
Besides, in that class of children the mucous coat of the stomach 
is relaxed, and there is a large accumulation of mucus in that 
viscus, which, when thrown off, lets the natural appetite for 
food return, and more perfect digestion takes place. Bowels to 
be regulated with cascara ; bathing morning and night ; flannel 
clothing ; patient placed upon a general course of alteratives 
and tonics — iodide of potass, and preparations of cinchona. 

The diet to be most nourishing, consisting of abundance of 
animal food, beef, mutton, poultry, eggs, milk, cream, oatmeal 
porridge and cream, boiled white-fish. 

(6.) Granular Ophthalmia. — May be a result of either of the 
preceding forms, or may come on of itself from the same causes, 
and consists in a low form of irritation of the conjunctiva, with 
effusion of lymph, which forms nodules or granules, rendering 
the conjunctiva uneven and granular. These granulations look 
like grains of sago, and consist of inflamed mucous follicles and 
papillae ; they cause a good deal of irritation, and opacity of the 
cornea is the result. 

Treatment. — Alteratives and tonics, iodide of potass and qui- 
nine being the two best ; the eye, or rather the granulations, to 
be brushed over three times a week, if irritation is produced, 
with a solution of iodide of potass, from five to twenty grains to 
the ounce of water, or aromatic sulphuric acid, pure or diluted, 
according to age of patient ; bowels regulated ; daily bathing ; 
flannel clothing ; best of nourishment. If case does not yield 
promptly to above means, with rest to the eye and darkness, 
apply two small blisters one inch square on each on spinal col- 
umn at nape of neck for six hours every other day, the succeed- 
ing blisters to follow on the top of the former ones. 



608 DISEASES OP THE EYE AND EAR. 

(7.) Rheumatic Ophthalmia.— The coat or covering of the 
eye below the mucous membrane is a white, fibrous tissue, and if 
it is depressed by cold, wet, or violence, and there is the presence 
of lactic acid in the blood (rheumatism), it becomes specially 
affected or irritated with the acid, which has such a strong 
affinity for it. 

Symptoms. — Severe, sharp, lancinating pain in the eye and 
side of head. It is so agonizing that it depresses nerve centres, 
and there is more or less fever ; the white of the eye looks a pale 
red, its vessels being arranged in a radiated or zonular form, 
and beneath the conjunctiva; intolerance of light ; dimness of 
vision, from haziness of cornea and contraction of pupil ; the 
discharge from the eye is watery or serous ; there is no sensation 
of sand, no fleshy condition of conjunctiva, no muco-purulent 
discharge, no soreness or rawness ; but a sharp, lancinating pain, 
always worse at night. 

Treatment. — General treatment tor rheumatism : atropia 
solution dropped in eye thrice daily ; dry heat to eye and side 
of head ; never wet applications of any kind ; blisters for six 
hours to nape of neck, repeated every other day, followed by hot 
poultices ; pain to be relieved, at all hazards, with morphia or 
opium ; control fever ; aconite and veratrum ; open bowels ; bathe 
surface ; quinine and salicylate of soda every three hours, with 
general alteratives and tonics ; same remedies as for rheuma- 
tism ; saccharated sulphur after meals. If symptoms do not 
ameliorate very speedily, use a two per cent, solution, hypodermi- 
cally, of the nitrate of pilocarpine, which exerts a most wonder- 
ful influence in this affection. The pilocarpine is most effectual 
in the most intractable cases. Still hold on to aconite, colchi- 
cum, and cinchona in addition. 

(8.) Catarrhal Rheumatic Ophthalmia. — This is a com- 
bined affection, consisting of both inflammation of the mucous 
membrane and also of the sclerotic coat. Usually present in 
greatly broken down subjects. 

Symptoms. — Pain ; both sore, raw, lancinating ; also sensa- 
tion of sand ; intolerance of light ; fleshy condition of conjunc- 
tiva, or chemosis ; often leads to opacities of cornea, ulceration, 
onyx, suppuration, etc. 

Treat with alteratives and tonics ; build up in every possible 
manner; drop atropia in eye ; relieve pain with morphia; stimu- 
late optic nerve with quinine ; give best of food, and observe 
great cleanliness. 

(9.) Sympathetic Ophthalmia. — This is induced in one eye 
by the irritation set up in the other, either as the result of an 
ophthalmia, or some degenerative change going on in a diseased 
or damaged eye, or lost eye. 

The disease usually commences with intolerance of light, then 



DISEASES OF THE EYE AND EAR. 609 

pain, impairment of vision. The inflammation is of a plastic 
form, which is superficial, and runs to deeper-seated parts. 

The great point in the treatment of such cases is alleviation 
of pain and toning up the eye with preparations of cinchona. 

(10.) Pterygion. — As a final result of repeated irritations, or 
inflammation of the conjunctiva, the blood vessels of the inner 
or outer corner, or canthus of the eye become relaxed, con- 
gested, and become varicose, forming a triangular, fleshy excres- 
cence on the conjunctiva. Vessels can be hooked up, and 
snipped off, but a better plan is to touch or brush over the di- 
lated vessels with aromatic sulphuric acid, once, twice, or more 
times a week; and if that fails, a solution of nitrate of silver, 
fort} 7 grains to ounce. 

DISEASES OF CORNEA. 

That portion of the covering of the eyeball next to the conjunc- 
tiva is called the cornea, from its fancied resemblance to a horn ; 
transparent and nearly circular, forming the anterior sixth of 
the globe. It is a structure of extremely low organization ; 
difficult to induce a condition of partial death in it, by either 
violence, contiguous inflammation, unless the vital forces are 
very low, shattered in the extreme, or some cachexia, as 
tuberculse, syphilis, gout, etc., be present. 

(1.) Acute Corneitis. — May be the result of injuries, cold, 
wet, exposure in depraved subjects, or inflammation from other 
parts. When it takes place, it renders the polished and trans- 
parent surface of the cornea hazy, dim, and rough, or to look 
like ground glass. 

Symptoms, — Dull, deep-seated pain in the eye ; intolerance 
of light ; abundant secretion of tears ; no muco-purulent dis- 
charge of any moment ; a concentric plexus of minute vessels 
can be seen passing from edge of cornea ; a zone of pink ves- 
sels in adjacent sclerotic ; haziness of cornea, with opacity. Pa- 
tient affected very tuberculous ; disease runs a very chronic 
course, lasting for months, leaving cornea permanently cloudy ; 
sometimes ends in suppuration, and softening is liable to take 
place, with perforating ulcer into cornea. One or both eyes may 
be affected. 

Treatment, — If any fever, aconite and veratrum ; active con- 
dition of liver and intestinal secretions ; blisters to nape of neck 
every other day for six hours ; alteratives — iodide in compound 
syrup of phytolacca, stillingia, iodide of lime ; and tonics, as 
preparations of cinchona, quinine, glycerite of ozone, and keph- 
aline ; warm fomentations to eyes ; very best of food, and every- 
thing calculated to build up vital force. 

(2.) Gouty, Syphilitic Keratitis, — Chronic interstitial kera- 



51 



610 DISEASES OF THE EYE AND EAR. 

titis may depend on gout, syphilis, mercury. Affects specially 
young persons and females. It is very chronic. 

Symptoms, — No pain ; a diffused haziness, beginning at cen- 
tre of one cornea ; tissue affected resembles ground glass ; no 
tending to ulceration; after a few weeks other cornea becomes 
affected. Subjects of this disease afford strong indications of 
either hereditary gout, syphilis, or mercury. 

Treatment, — Same as the above : alteratives and tonics, and 
best of support. 

(3.) Opacity of the Cornea, — Invariably a result of inflam- 
mation, and effusion of lymph into the cornea, or between it 
and the conjunctiva. 

When the effused lymph is light and cloudy it is called 
nebula; a limited white patch, such as results from a cicatrix, 
is called albugo ; and if it is very dense, of the consistency of 
ivory, leucoma. Absorption may take place under alteratives 
and tonics, with local use of brushing on iodide of potass in solu- 
tion ; or aromatic sulphuric acid, or alum and white of egg 
emulsion to eye, in nebula and albugo ; but they are useless in 
leucoma. 

(4.) Ulcers of Cornea, — If the person affected with chronic 
keratitis, or effusion of lymph nebula, albugo or leucoma, 
be subjected to depressing influences, as sickness, bad or insuf- 
ficient food, tuberculse, syphilis, or other lowering disease, the 
effused lymph may break down, and an ulcer form, which 
may lead to perforation of the cornea and escape of the 
aqueous humor. Improvement of general health is the best 
preventive as well as cure. 

(5.) Conical Cornea. — A somewhat rare malformation. Cor- 
nea found exceeding convex, giving a peculiar sparkling, or 
brilliant appearance to the eyes. Both eyes are usually affected, 
but often unequally. Vision may be indistinct; cause is un- 
known. It seems to consist in a thinning of the cornea. No 
treatment of any use. 

(6.) Arcus Senilis, — A gradually increasing opacity of the 
circumference of the cornea, resembling the white portion at 
bottom of nail of thumb. It is indicative of fatty heart, liver, 
and kidneys. 

DISEASES OF THE IRIS. 

The iris, suspended like a curtain, with a circular opening 
in its centre, lies between the cornea and crystalline lens ; and 
bathed on both sides by aqueous humor, serves to regulate the 
amount of light that is admitted into the retina. It divides 
the cavity containing the aqueous humor into anterior and 
posterior chambers. The iris is composed of delicate bundles 
of fibrous tissue, or circular and radiating, involuntary, mus- 



DISEASES OF THE EYE AND EAR. 611 

cular fibres, and of pigment cells. In some cases it is absent, 
or exists in a rudimentary form. In the Albino, the iris is of 
a rose-color, while the pupils present a deep red appearance, 
owing to absence of opaque pigment. In coloboma, the two 
halves of the iris have failed to unite, in consequence of an ar- 
rest of development, which gives the pupil an elongated form. 
Inflammation of the iris exists in a variety of forms, and is asso- 
ciated or dependent on low states of vital power. The differ- 
ent forms of iritis are divided into (1.) hyperemia of iris; (2.) 
plastic iritis ; (3.) serous iritis ; (4.) parenchymatous iritis ; (5.) 
syphilitic iritis. 

Causes. — Syphilis, gout, tuberculse, mercury, are the prim- 
eval causes but exposure to sudden changes of temperature, 
cold draughts, or severe drenching, together with grief, anxiety, 
sleeplessness, may induce it if the predisposition exists in a 
depraved constitution. 

Symptoms. — There is lancinating pain, situated at first, in 
the interior of the eyeball ; then it extends to the forehead, 
temple, and gums, and other parts of the fifth nerve. Throb- 
bing is an unfavorable symptom. Pain increases towards 
evening and lasts till morning, when it has assumed a dull 
aching in the eyeball, and occasionally it is of a lancinating 
character. The nocturnal attacks of pain are very apt to 
cause fever and impaired appetite. Intolerance of light and 
lachrymation are rarely absent, but very slight. Now exam- 
ine the eye. Direct your attention to its color ; compare it 
with the healthy iris, and see if it has not undergone some 
change, for inflammation changes blue into greenish, brown 
into reddish, gray into greenish-yellow color ; and if blood is 
effused into the anterior part of vitreous humor, it presents 
a green color. The arterial distribution accounts for those 
changes. There is also contraction, dryness, and irregularity 
of the pupil, dimness of vision, and sometimes total blindness. 

The different forms depend upon the cause — the syphilitic 
form is the most common, and is usually associated with other 
symptoms. Its chief distinctive characteristic is that instead 
of the whole iris being studded over with excrescences, the 
inflammation is confined to one or two single spots ; while the 
rest is normal. One-fourth, or one-half of the iris is changed 
in color, and swollen. 

Treatment. — This embraces general principles : aconite for 
fever ; morphia for pain ; free action of bowels and skin ; nour- 
ishing food, etc., etc. 

Our effort must be directed to the eye to obviate the ten- 
dency to adhesions, or break them down ; for this purpose, a 
solution of atropine breaks them up, if fresh, and puts the eye 
in a favorable condition toward resolution. The solution, in 



612 DISEASES OF THE EYE AND EAR. 

cases of iritis, must be strong (six grains to the ounce), of which 
six or seven drops should be dropped into the eye three times 
a day. The eye to be kept closed, and eyelid and side of head 
painted with extract of belladonna ; mustard, followed by hot 
poultices, to nape of neck. 

A general course of alteratives and tonics, keeping in view 
that our two best are iodide of potass and sulphate of quinine. 
In addition to those two remedies, spirits of turpentine has a 
most marked action on the iris. It should only be given a 
few days at a time, but when administered should be given in 
fair doses ; otherwise the treatment should be of the most con- 
structive kind. 

INFLAMMATION OF THE CHOROID. 

The second, or vascular and pigmentary tunic, or covering 
of the eyeball, is rarely alone affected. If it should occur, in- 
flammation spreads rapidly to other structures of the eye, caus- 
ing disorganization. 

Symptoms, — Intolerance of light ; laehrymation, dimness of 
vision ; supraorbital pain ; engorgement, more or less, of con- 
junctiva ; displacement of pupil ; thinning of sclerotic; opacity 
of cornea, and enlargement of globe. 

Treatment, — Same as for Purulent Ophthalmia. 

RETINITIS, 

Inflammation of the delicate net, or web, or membrane, 
called the retina, is rare, although it sympathizes with all the 
inflammatory conditions of the eye. 

Causes.— Exposure to vivid light; such as the glare of 
snow, the white sand in tropical latitudes, large fires in foun- 
deries, and molten iron. 

Symptoms, — Acute, deep-seated pain in the eyeballs, ex- 
tending to temples and forehead ; great intolerance of light ; 
dimness of vision ; frequent sensations of flashes of light ; 
pupil contracted to a pin-point ; iris loses its brilliancy and 
becomes motionless ; some vascularity of sclerotic and con- 
junctival coats ; constitutional disturbance ; high fever, and 
delirium. If not carefully managed irreparable blindness lia- 
ble to take place. 

Treatment. — Perfect rest in a dark room ; veratrum, aconite, 
for fever ; morphia, or opium, or hyoscyamus for pain, which is 
to be relieved at all hazards ; bowels to be freely opened ; skin 
stimulated by frequent bathing and jaborandi ; heat to feet — 
after mustard. To nape of neck, a four-inch square mustard 
plaster, followed with croton oil, then poultices, and latterly 
irritating plaster. To the eye, warm fomentations of opium 



DISEASES OF THE EYE AND EAR. 613 

and tepid water, or infusion of poppies ; alteratives and tonics, 
iodide potass and quinine. 

As to the great value of stimulating applications to nape of 
neck, there can be no doubt in all eye affections. The optic 
nerve originates in the spinal cord and medulla, so that a good 
stimulant at root induces contractility, and normal vigor in 
the main trunk, and in its finer mechanism or reflexion in the 
optical instrument, the eye. In all eye diseases, aside from 
children, our motto is active stimulation to its origin. 

CATARACT. 

Consists of an opacity of the crystalline lens, or its capsule, 
or both ; the effect being to intercept the rays of light on their 
way to the retina. Three forms are usually recognized accord- 
ing to situation of opacity, viz., lenticular, capsular, and cap- 
sulo-lenticular. 

Causes. — The causes that give rise to opacity of the crystal- 
line lens are either inflammation or degeneration of structure. 

Symptoms. — Hard or lenticular cataract, or degeneration 
is the most common form met with in both sexes between 
fifty and seventy years of age. It causes objects to be seen as 
if through a thick cloud, or gauze — allows vision to be more 
clear when pupil is dilated with atropine, or by turning back 
to light. In advanced cases vision is reduced to distinguish- 
ing light from darkness. Commonly, one eye becomes affected 
first ; then the other. Movement of iris natural ; when pupil 
is dilated with atropia cataract can be distinctly seen with a 
glass of small focus ; when cataract forms, lenticular opacities 
can be readily seen b\ r ophthalmoscope. 

Soft, or lenticular cataract of } r oung people, may occur at 
any time of life. Congenital cataract is of this kind, due to 
disintegration of the whole substance of lens, which becomes 
opaque and swollen. Symptoms are the same as the hard, 
only vision more imperfect. This form often depends, or is 
caused, by a defect in the co-ordinating chemical centre in 
the brain ; hence it is common in diabetes, and other diseases 
connected with that part of the brain. 

Capsular cataract is more especially the result of chronic 
inflammation and effusion of lymph into its covering; opacity 
of a dead white color ; it may affect any portion of capsule. 
Opacity of capsule always leads to opacity of lens, so that cap- 
sulo-lenticular cataract is very common. 

Treatment. — Various efforts to promote absorption of cata- 
ract have been tried ; the most successful has been in the early 
stage of hard and capsular cataract, chiefly with iodide of potass 
internally, and by bringing fumes of fluoric acid in contact 
with the eye until the eye manifests a slight congestion. It 



614 DISEASES OF THE EYE AND EAR. 

should not be resorted to oftener than three times a week, and 
must be done very carefully, by putting the acid in a wide- 
mouthed, rubber bottle, guarding mouth, nostrils, and other 
eye, and holding it up to the affected eye, so that its fumes 
come in contact with the eye. 

Common treatment is by operation, and one of three forms 
is usually selected, viz : — 

(1.) Depression, displacement, or couching, by which the lens 
is pushed from its natural position, so as to allow rays to pass 
through pupil to retina. 

(2.) Solution or absorption, in which the body of the lens is 
broken up at several sittings, so that it may be absorbed ; only 
of utility in soft cataract. 

(3.) Extraction, by which the lens is removed entire through 
an incision in cornea. 

GLAUCOMA. 

A form of blindness attended with disorganization of the 
various tissues of the eyeball, in which objects are surrounded 
by various colors, especially blue and green. 

Causes. — It seems to depend upon extravasation of blood 
in retina and choroid ; serous effusion between retina and 
choroid ; retina raised in folds ; and clots in vitreous humor, 
and changes in the optic nerve. What induces such changes, 
aside from shocks, jars, concussions, it is impossible to say. 

Symptoms. — It may be acute or chronic, that is, it may come 
on suddenly, or more slowly ; take months to do so. In both 
there is a rapid and irreparable loss of vision ; begins with 
intense pain in the ball of eye during night, with throbbing 
in both eye and temple. Pain continues, and the eyes become 
congested. Iris of a dusky hue, and motionless ; cornea be- 
comes dim ; pupil widely dilated, and sometimes of an oval 
shape; eyeball unusually hard. Everything looks as if sur- 
rounded with prismatic colors ; often bright flashes of light 
before eyes ; both eyes are affected. 

In the chronic form the symptoms are the same; perhaps 
more congestion of iris and cornea, and more fullness of eye- 
ball. Opacity of the lens is common in chronic form, as a 
result of deranged nutrition. 

Treatment. — So far there is no known mode of treatment 
that avails. The improvement of general health and relief of 
pain is about all that can be done. Any depressing treatment, 
anything that weakens the patient, aggravates the trouble, so 
that the careful administration of sulphate of quinine, ozonized 
glycerite of kephaline, and other elements to invigorate the 
brain, should have a trial, with change of scene, and a sea 
voyage, etc., etc. 



DISEASES OF THE EYE AND EAR. 615 

AMAUROSIS, OR BLINDNESS. 

Partial or complete amaurosis, or loss of vision from some 
disease of the retina, optic nerve, or brain, the optical instru- 
ment, the eye, being in a normal or healthy condition. The 
causes that are likely to affect the brain, optic nerve, or retina 
are embraced under five distinct heads, viz., anaemia, hyper- 
emia, reflex, poisons, organic changes. 

General Symptoms. — Partial or complete loss of vision, 
without effusion in the cornea or on lens, or any form of opa- 
city. This impairment of vision naturally gives the gait and 
countenance a peculiar expression. He walks with an air of 
uncertainty ; his eyes, instead of being directed to surrounding 
objects, have an unmeaning look, appear to be staring at nothing, 
or are in constant rapid motion. In partial amaurosis, move- 
ments of the iris sluggish, and pupil dilated ; in total blindness, 
pupil greatly dilated, and iris immovable. When both eyes are 
affected, they are often unnaturally prominent, and of an un- 
healthy color, the sclerotic being often yellow and covered with 
varicose veins. 

An examination of the eye with the ophthalmoscope usually 
reveals inflammation of the optic nerve ; changes in the retina 
or brain. Those changes are variable, consisting chiefly of 
relaxation, effusion, thickening deposits, and extravasation. 
Another class seems to depend on atrophy, or wasting of the 
retina, optic nerve, or brain. This atrophy may follow neu- 
retis, or exist without. "When due to tobacco, this shrivelling 
up or whittling down of retina and optic nerve proceed to utter 
blindness without inflammation being present. 

(1.) Blindness due to ansemia will exhibit an impairment of 
vision, with all the symptoms of a diminution of red corpuscles 
in the blood, as vertigo, ringing in ears, specks or spots before 
eyes, pale face, lip, tongue, murmurs in left carotid, and general 
debility. The causes that lead to this may be meagre, poor, or 
bad food, absence of sunlight, over-work, drugs, disease, fevers, 
long or excessive nursing, want of exercise, sexual excess. 

Best cured by a removal of cause, building up blood with 
abundance of best of food, fresh air, exercise, and by the use of 
compound tincture cinchona and mineral acids, or pill quinine, 
iron, hydrastin, nux, sulphate quinine, and aromatic sulphuric 
acid. 

(2.) Blindness due to congestion or plethora, or over-feeding and 
stimulation, with all the symptoms of that condition. 

Best treated with removal of cause or causes, free purgation, 
heat to feet, blisters to nape of neck, followed by irritating 
plaster; alteratives, as iodide of potass in syrup of stillingia or 
Phytolacca ; and even here, cinchona or its alkaloids, because 



616 DISEASES OF THE EYE AND EAR. 

we have no drug equal to it in restoring the integrity of the 
optic nerve 

(3.) Blindness may be due to reflex irritation, as the irritation 
of teething, worms, ovary, uterus, pregnancy; but more espe- 
cially self-pollution, or masturbation. This latter form usually 
common, as all the inmates of our prisons, refuges, asylums, 
boarding-schools, retreats, are addicted to this loathsome and 
degrading practice. Nearly all the young and middle-aged men 
and women to be seen on our streets with defective vision and 
glasses, have been inmates oi some charitable college or insti- 
tute, and exhausted, drained off, their nervo-vital fluid, and 
obliterated the finer cerebral convolutions of their brain, and 
are partially blind. The origin of the optic nerve being in 
the spinal cord, medulla, and brain, the reflex centre, or bulb, 
suffers intense!;/, and the whole process of growth is arrested, 
and the perpetrator a miserable victim of self-conceit, egotism, 
and puniness. 

Cured upon general principles, by removing cause, and treat 
for masturbation and for the eye ; stimulants to nape of neck, 
quinine, glycerite of ozone, kephaline, and other tonics. 

(4.) Blindness may be due to poisons, as tobacco, chloral hydrate, 
opium, whisky, belladonna, conium, syphilis, mercury, and to 
the use of hair dyes and cosmetics, as the nitrate of silver, lead, 
bismuth, which acts very disastrously upon base of brain along 
the ophthalmic tract. Much of the defective vision to be seen 
is due to the use of those agents. 

A discontinuance of the use of the poison, with a general 
alterative and tonic course, is usually sufficient for a cure, if 
seen early. and persevered with. 

(5.) Blindness may be Due to Organic Changes in the Retina, Optic 
Nerve, or Brain. — These changes may be inflammatory, and pro- 
ceed on to softening of the nerve or its branches, or due to 
atrophy from anaemia or want of nutrition. This is the most 
hopeless form, as white softening, or ramollissement, is an irre- 
parable affection. 

General Treatment. — In all cases, if it is possible or practi- 
cable, the following plan of procedure should be carried out: 

The bowels regulated ; skin stimulated with daily baths ; two 
open sores at nape of neck, one inch square, on each side of the 
spinal column ; flannel clothing ; appetite to be stimulated, and 
a diet consisting of animal food, eggs, white-fish boiled, oatmeal 
porridge, and cream — a brain diet, an important factor in a 
a case. As the optic nerve not only originates in the spinal 
cord, but is freely blended w T ith the medulla, the seat of reflex 
action, morning and night all the peripheral extremities of the 
nerves of the entire superficial portion of the body should be 
stimulated from half an hour to two hours with friction, sham- 



DISEASES OF THE EYE AND EAR. 617 

pooing, palpation, and electricity. This faithfully performed, 
raises the standard of vitality of cord and bulb, and the patient 
sees better at once or after a few applications. The medical 
treatment is the same as for chronic inflammation and soften- 
ing of brain — alteratives and tonics, iodide of potass, cinchona, 
and especially the ozonized preparations, as they tend to cleanse 
brain and optic nerve of all extraneous substances; glycerite of 
ozone, ozone-water, kephaline. Treatment to be persevered with 
for six or twelve months ; change of air and scene often of 
utility; other cases benefited by rest and quietness, especially 
those caused by exhaustion and nervous debility. 

If a real organic change has taken place in the optic nerve, 
all remedies are useless. In all cases there should be an avoid- 
ance of all malt or alcoholic liquors ; all acro-narcotic drugs, 
especially tobacco, and hair dyes or tonics; and sexual congress 
at rare intervals. Probably of all causes that give rise to the 
great frequency of organic amaurosis, tobacco and syphilis are 
the most common and detrimental, and most likely to produce 
degeneration of the optic nerve. 

THE LACHRYMAL, OR TEAR DUCT. 

This gland is often subject to acute and chronic inflammation. 
The cause is usually exposure ; the symptoms and treatment 
same as other forms of inflammation. 

(1.) Kerophalmia. — A deficiency of tears, a dryness of the 
eye, an absence of the mucous secretion, maybe due to intense 
grief, or local depression, and may be palliated by the applica- 
tion of glycerine, or infusion of quince seed, and an eye-cup, 
until the mental condition can be restored, 

(2,) Epiphora, — This signifies a redundancy of tears, an over- 
secretion. Its common cause is an irritation of the sympathetic ; 
but it is met with in general irritability of the eye, especially in 
rheumatic and scrofulous ophthalmia. An occasional emetic; 
dry heat to the eye, if rheumatic ; the salt-water lotion, if tuber- 
cular ; and general treatment according to the cause present. 

(3) Closure of the Puncta Lachrymalis and Obstruction 
of the Nasal Duct. — It may be congenital, but it is more gene- 
rally found to be due to the results or effects of inflammation 
of the sac, to effusion of lymph, and thickening. 

The obstruction, from whatever cause, almost invariably gives 
rise to either acute or chronic inflammation in itself of the lach- 
rymal sac, and sometimes fistula. Besides, the tears escaping 
on the cheek give rise to irritation and er}'thema of the skin. 

In the treatment, the condition of the stomach, bowels, skin 
should be very carefully attended to, fever allayed, and hot 
fomentations of poppies to the eye. A snuff of bayberry and 
capsicum should be tried, so as to dislodge any lymph in the 



618 DISEASES OF THE EYE AND EAE. 

opening into the nose ; or he should draw in the breath, and 
hold the nostrils and mouth closed, so as to draw the tears 
down the duct by the pressure of the atmosphere ; try an emetic 
of lobelia, and a generally alterative course ; inhalation of iodo- 
form and ether, tincture of iodine and iodide of potass. All 
means failing, a gold style should be introduced, and worn for 
a sufficient length of time. The constant pressure of the instru- 
ment causes the duct to dilate, so that the tears flow by its side. 
It should be taken out occasionally and cleaned, and then re- 
placed. It affords very great comfort, and after wearing it a 
couple of months, it can be often altogether dispensed with. 
The style should have a round head, a little bent at the upper 
end, as this enables it to sit better and irritate less. Short pieces 
of catgut and other bodies are sometimes used instead, but none 
can excel in utility the gold style. 

SQUINTING. 

Squinting, or strabismus, is a want of harmony in the mus- 
cles of the eye. The common form met with in young persons 
is where the eye is turned inwards, or, convergent; the other form, 
in which the eye is turned outward, or divergent, is more rare, 
and is chiefly met with in elderly persons, from paralysis of 
the internal muscles. Both eyes may be affected, but this is 
not common. 

The causes of squinting are very numerous. It maybe con- 
genital, or induced by bad habits, bv imitation, by looking at 
pimples on the nose ; or it may come on from a stye, which 
often interferes with the motion of the eye ; by the use of one 
eye to the neglect of the other, or by shading one ; it may 
also result from slight opacities of the cornea ; from a variety 
of nervous causes, and it is often the result of reflex irritation 
in morbid conditions of the stomach, worms, teething and con- 
stipation ; disorders of the sympathetic system, as fright, pas- 
sion, etc., and also to disorders of the brain, as convulsions, con- 
gestion, effusion, hydrocephalous, etc. 

Treatment. — If it be recent, that is not over a few weeks' 
standing, the difficulty can be frequently overcome by the re- 
moval of the causes, as teething, worms, disorders of the stom- 
ach and bowels, by the proper remedies ; by avoidance of study 
and reading ; by proper exercise to the eyes, and by wearing 
glasses for the purpose. But if the squint be of long standing, 
and is habitual, and above all, if there is the slightest dispar- 
ity in vision of the two eyes, very little good can be effected, 
unless the internal rectus muscle be divided. This is a very 
simple proceeding, consisting in placing the patient under 
chloroform and placing a blunt hook under the muscle and 
raising it, and then dividing it. If the squint depends on 



DISEASES OF THE EYE AND EAR. 619 

some opacity of the cornea, or organic disease of the brain, no 
interference should be permitted. 

Protrusion of the eyeball is a general symptom of wasting 
disease, as consumption, anaemia, but it may be due to aneur- 
isms, tumors, fatty deposits, osseous and encysted growths. 
The danger of tumors are twofold : destruction of the eye 
from continued pressure ; and protrusion through the roof of 
the orbit into the cavity of the skull, with compression of the 
brain. The diagnosis is most important. 

Cancer of the Eye may take place in a variety of forms — 
on the lids, behind the eye, and in the eye itself. At its incep- 
tion, or during some part of its course, it usually runs into a 
melanotic form. 

It is very easily recognized, by the pain and cachexia. 

Its treatment should be chiefly by internal remedies to destroy 
the germ in the blood, as the ozonized cancer alterative, and 
glycerite of ozone, ozone-water, chian turpentine, and other 
antiseptics. 

THE EAR. 

The auricle, or external ear, forms an important element in 
man, and serves a variety of purposes, such as the protection 
of the delicate organ which it surrounds ; preventing sensible 
perspiration, as it trickles over the head, from entering the ear ; 
protecting it from wind and weather, dust and rain, the rays of 
the sun, and warding off various substances in active life. 
The mobility of the auricle causes wax to become dislodged 
and fall out. It also aids in maintaining an equable tempera- 
ture and a proper degree of natural moisture within the ear, 
and assists in the catching of the undulations of sound, a sound 
conductor, or condenser, an assistant in transmitting the vibra- 
tions to the inner ear. Its use then may be briefly enumerated : 
to protect the ear, and in catching sound, or sound waves, and 
of aiding in conducting them to the inner ear; it gives know- 
ledge, also, of the direction of sound, and quickens the per- 
ception of musical notes. It is subject to all the various dis- 
eases of the skin, to various growths and tumors. 

DISEASES OF THE EAR. 

The human ear is a perfect instrument of acoustics. Its me- 
chanism is so arranged that the undulations of sound are trans- 
mitted or impressed upon the auditory nerve, or brain, in the 
most definite manner. The brain is the organ of hearing, the 
ear being simply the medium through which it receives its 
impressions. This, of course, reduces all diseases of the ear to 
two classes — the ear and brain. The human ear is subject to 
the same fundamental laws of physiology and pathology as 



620 DISEASES OF THE EYE AND EAR. 

the rest of the body. This at once simplifies our investiga- 
tions on ear diseases. Indeed, an overwhelming majority of 
ear diseases are due to inflammation and its results, and in this 
process various parts of the organ may be affected ; all em- 
braced under one general term — Otitis. 

(1.) Inflammation of External Meatus. — The canal lead- 
ing into the ear is often alone affected. The very sensitive 
lining of the canal may be inflamed from the introduction of 
irritating matter, an accumulation of hard wax, blows, cold, 
syphilis, tuberculse, gout, rheumatism, and poor states of the 
blood. 

Symptoms. — Dull, aching pain, increased on moving the 
jaw. Parts red, swollen, tender ; the tumefaction being so 
great in some cases, as to close the canal and cause temporary 
deafness. There is likely to be swelling of the cervical glands 
on the affected side. In a day or two, a copious secretion of 
mucus — often w T atery, but abundant. In chronic cases there is 
a steady muco-purulent discharge from the ear, or otorrhcea ; 
the dermis, or lining of canal, remains swollen ; epithelium 
thrown off in scales, which accumulate and obstruct canal ; 
hearing is impaired ; great itching and general depression. 

In some cases small abscesses, styes, or boils form, which may 
give rise to rigors, throbbing, narrowing of the canal, or col- 
lapse of its walls, and dullness of hearing. 

Treatment. — If there is fever give aconite and belladonna, 
and general treatment as laid down, with local dry heat ; attend 
to skin, bowels, and wash out the part frequently with warm 
soap and water, tonics ; antiseptics and best of diet. 

(2.) Inflammation of the Membrana Tympani and Mid- 
dle Ear, — Beyond all question, the diseases of the auditory 
apparatus, which occur most frequently and possess the great- 
est interest, are the inflammatory affections of the tympanum 
and middle ear. The middle ear properly consists of the mem- 
brana tympani, the tympanitic cavity, the mastoid cells, the 
chain of ossicles, and certain muscles, vessels, and nerves. In 
a small, confined space, we have a most delicate, intricate struc- 
ture, performing important functions ; easily disturbed by the 
standard of health, by a variety of causes, and attaining in- 
creased importance from their contiguity to such vital parts as 
the labyrinth, the internal jugular vein, the internal carotid 
artery, the dura mater, and several venous sinuses of the brain, 
so when we look at the parts implicated, there should be no 
apathy in our treatment, no ignorant, officious meddling. 

Causes. — It may arise from cold, damp, exposure, rheuma- 
tism, gout, boils, injuries, or accidents, injudicious tampering 
with the ear with hair pins. It may also be due to extension 
of inflammation inwards, or upwards from the pharynx, car- 



DISEASES OF THE EYE AND EAR. 621 

iying the germs of scarlet fever, quinsy, diphtheria, measles, 
smallpox, whooping cough, catarrh, pneumonia, bronchitis, in- 
fluenza, syphilis, mercury, tuberculre, and the use of nasal- 
douches. A\ hen the inflammatory action reaches the throat, it 
travels along the eustachian tube, which is the channel de- 
signed by nature for maintaining a due equilibrium between 
the atmospheric and tympanitic air, and for draining super- 
fluous mucus from the tympanum. When all is well it serves 
those purposes admirably, but when disease exists it serves as a 
channel for carrying diseased germs up from the pharynx. 
The tube is short, being one-and-a-half inches in the adult, 
but its continuity of mucous membrane permits an easy road 
for the germs to travel, and more so if it is a young child, in 
whom the tube is much shorter and more open than in the 
adult. Dentition, first and second periods, are productive of 
inflammation of the middle ear. The vaso-motor impressions 
are readily conveyed from the inflamed gums to the correlated 
membrana tympani by the dental nerve, and the nervi-vaso- 
rum of the tympanitic branch of the internal carotid artery. 
There can be little doubt that the difficult or retarded dentition 
due to a want of phosphates in the modern mother's milk, is 
a common cause of inflammation of the inner ear. It is im- 
possible to doubt it when we look at the troubled little face, the 
resting of the head on the nurse, the thrill of agony that passes 
over its features, accompanied with piteous cries or shrieks 
when its position is moved, especially if done suddenly ; and, 
more than all, the constant raising of its little hand to the side 
of the head : all indicate the agonizing sufferings of earache. 

Of all living diseased germs, those of scarlatina are most 
destructive to the ear, give rise to hopeless chronic affections, 
or drift into deafness. The ear, in scarlet fever, is about as 
obnoxious to irritation as the kidneys, and when we bear in 
mind that every congestion of the lining membrane of the ear 
is a true periostitis, and every ulceration a caries of its osseous 
walls, so that with better care, a true appreciation of germ- 
diseases, a more thorough antiseptic course, many lives might 
be saved, useful ears spared, and deaf-mutism become a rare 
exception. 

Symptoms. — General symptoms of inflammation, headache, 
pain in back, legs, rigors, and a fever ; uneasiness in ear, fol- 
lowed by sharp, lancinating pain in the inner ear, increasing 
in severity ; there are also impairment of hearing, giddiness, a 
sense of fullness in the head, and an increase of pain in moving 
jaws, mastication, or swallowing, moving the head, or blowing 
the nose. On examination of the membrana tympani, it is 
found red and congested. Beating noises in the ears ; eyes 
become injected ; countenance anxious ; fever greater ; function 



622 DISEASES OF THE EYE AND EAR. 

of skin, kidneys, and bowels disordered. There may be delir- 
ium or convulsions. There is always great depression and 
despondency. If case is not seen to there may be facial paraly- 
sis, from a spreading of the inflammation, power often regained 
when morbid action ceases. Should the attack be a slight one, 
or the vital force vigorous, and treatment appropriate, perfect 
resolution may take place ; but if powers of life are low, sup- 
puration may take place, pent-up pus bursting on discharging 
itself, if in inner ear, by perforation of membrana tympani ; or 
in more grave cases the inflammatory process spreads into the 
mastoid cells internally, or by bony meatus to the periosteum, 
covering the mastoid process externally. 

In external otitis, perforation of the membrana tympani may 
take place, owing to the extension of inflammation from within 
outwards. 

The disease usually runs a very rapid course, suppuration 
often taking place in from twenty-four to forty-eight hours from 
its inception, a significant fact for rational and active treatment. 

Treatment. — The cause, if it can be removed, should be done 
promptly. Then patient should be put to bed in a warm room, 
70° F., moist atmosphere, well ventilated, comfortable, .and free 
from all noise, no talking, the greatest quietness ; dry heat to 
the ear and side of head, such as hops, chamomile flowers, bran, 
or salt, in bags or pillows, made hot in oven ; and permit no 
food requiring mastication, for moving the jaws interferes with 
the rest of organ. The fever, as well as the local inflammation, 
must be regulated by arterial sedatives. To do this effectually 
administer a saline purge, or cascara, or both, and enemata, if 
not soon moved ; heat to feet ; aconite, belladonna, and sweet 
spirits of nitre freely. If the skin does not become moist, com- 
pound tincture of serpentaria, so as to cause free diaphoresis ; 
hot drinks ; near night either chloral or Dover's powder, so as to 
get a long sleep. The dry heat is of primary importance, and 
should be watched with care. Never poultice either an eye or 
an ear is an injunction to be obeyed. The idea of this line of 
treatment is, if possible, to prevent the formation of abscess, or 
suppuration, as that is a result to be dreaded, as we never can 
know how, when, or where it may terminate, or to what it may 
lead. Case, otherwise, should be placed upon alteratives and 
tonics. If there is a manifestation of gout or rheumatism, col- 
chicum, quinine, iodide of potass ; if upon teething, lance the 
gums ; as soon as fever, pain, etc., are relieved, alteratives and 
tonics. 

(3.) Otorrhcea. — Catarrh of the ear, or a purulent or muco- 
purulent discharge from the ear — a sequel or result of inflam- 
mation, or a symptom of polypus ; granulations ; thickening 



DISEASES OF THE EYE AND EAR. 623 

by lymph ; sebaceous tumor in meatus ; is a common and stub- 
born disease. 

Causes. — Irritation, inflammation, even if not appreciable, 
is the cause, so we have to recapitulate the causes of inflamma- 
tion of the middle and inner ear; teething and scarlet-fever in 
tubercular children ; in adults it may depend on gout, rheuma- 
tism, syphilis, and other depressed states of the system. The 
secretion is always contagious, being loaded with bacteria, if 
muco-purulent, but if very offensive, the oidium albicans are 
present in it. It may be tinged with blood. 

Symptoms. — A muco or muco-purulent discharge from the 
ear, either scanty or profuse, occurring all the time or ceasing 
at intervals. If the discharge is very purulent, that is, loaded 
with diseased germs, it may be corrosive or eating in its char- 
acter, and destroy the membrana tympani, the bones of the ear, 
or cause caries of the bony walls of the meatus and tympanum. 
Diseased germs may penetrate to the mastoid process of the 
temporal bone, or into the petrous portion of the same bone, 
until the brain or its membranes become involved in the un- 
healthy action. This event is ushered in with rigors, fever, 
and marked cerebral symptoms, and ultimately convulsions, 
coma, and death. Inflammation or abscess of the brain may 
be induced by extension of disease to the cerebral sinuses and 
veins, as well as the dura mater. If there is any cancerous 
cachexia, it may also be developed at this point. 

Treatment. — The first point is to wash out ear with tepid 
water and castile soap, and examine to ascertain if no growths 
or polypi exist. There being none, the instructions must be to 
syringe the ear out thrice daily with castile soap and tepid water, 
and after with some antiseptic injection, as a few grains of borax 
to an ounce of tepid water, or one-half to one grain of perman- 
ganate, or ten grains of chlorate; after injection, the walls of 
the meatus to be brushed over with either vaseline ointment 
or ozone ointment, or glycerine and borax, or glycerine and 
balsam of fir or Peru ; a little cotton-wool, saturated with either 
of these, to be placed loosely in the outer meatus, and changed 
frequently ; nothing to confine discharge in the ear ; if weather 
is cold, ear-laps ; then place patient on the following alteratives 
week about in succession : ozonized compound phytolacca, 
iodide of potass in stillingia compound. At the same time 
tonics, as sulphate of quinine and aromatic sulphuric acid, or 
compound tincture cinchona and mineral acids, or glycerite of 
ozone. Bowels and skin to be looked after ; clothing warm. 
The diet to be of the best, nourishing, and in abundance — ani- 
mal food, milk, eggs, fruit. Parents must bear in mind the 
chronic, stubborn nature of complaint, and persevere. True, 
other alteratives might be used, and also other tonics, but as a 



624 DISEASES OF THE EYE AND EAR. 

rule the above are excellent. All applications about the ear 
must be of the most soothing kind, and antiseptic in their chemi- 
cal character. 

(4 ) Haemorrhage from the Ear. — An escape of blood from 
the ear, or otorrhagia, may arise from various causes. It may 
be due to — 

(1.) The effects of inflammation, as granulations, polypi, excres- 
cences, and abscesses of the auditory canal, or to caries and 
necrosis of the petrous portion of the temporal bone, with de- 
struction of the membrana tympani. If spicula of bone woui.d 
any artery, it may be fatal. 

(2.) Persons falling from a great height directly on their feet, 
the vertebral column is unable to resist or ward off the impetus of 
the fall, and the whole iorce is spent upon the base of the skull, 
causing a fracture, by which a communication is established 
between the dura mater and middle ear. The membrana tym- 
pani being ruptured , blood and serum oozes externally. If both 
sides are equally affected it is regarded as unfavorable 

(3.) Wounds and idcerations of the auditory passage, in what- 
ever manner produced, by hair-pins, slate-pencils, foreign bodies. 

(4.) An extremely rarefied condition of the atmosphere, as on 
high mountains, up in balloons ; or down in mines, diving-bells, 
sneezing, coughing ; membrana tympani gives way. 

(5.) It may be a vicarious haemorrhage, and thus replace 
normal menstruation in atrophy of uterus. 

Polypus, Granular Growths, Thickening, etc., in the 
meatus, or canal leading into the ear, or in the middle ear, 
usually the result of inflammation or irritation, are best treated 
in the following manner: The affected ear to be thoroughly 
cleared out of all secretion by the injection of lukewarm water, 
then with castile soap- water in it to soften. Afterwards the ear 
to be well dried, and the head to be turned to one side, and a 
spoonful of warm alcohol poured into the ear, where it should 
be allowed to remain ten or fifteen minutes. This is to be done 
three times a day. The alcohol produces a slight burning sen- 
sation in the ear. If acute pain be excited, weaker solutions 
must be employed, afterwards the stronger preparation. The 
action of the alcohol on the polypus granulations is : it first 
whitens them by coagulating the mucus which lies on their 
sorface, and subsequently penetrates the tissues, producing coag- 
ulation in their vessels, and thereby leading to the shrinking 
of the new formations. The time occupied in the treatment 
varies from a few days to se\eral weeks, or even months. The 
soft, round cell polypi yield most rapidly, the firm, fibrous more 
slowly, but ail disappear completely, and leave no trace behind. 
The deductions that are adduced from a long and extended use 
of the drug are as follows : A radical cure for all forms of 



DISEASES OF THE EYE AND EAR. 625 

polypi of the meatus, ear ; excellent for granulations and thick- 
ening of the mucous membrane ; for the removal of all growths, 
thus superseding instruments and all other drugs. 

Relaxation of the Membrana Tympani, following inflam- 
mation, is a common cause of deafness. The proper tension of 
the membrane is of great importance to good hearing, to receive 
the vibrations or undulations. After inflammation it often loses 
its tone, and the vibrations do not act, and a dulness of hearing 
is the result. 

This is almost invariably cured by brushing the membrana 
tympani with collodion, which causes it to contract and produces 
the necessary tension. It should be brushed over very freely. 
It seldom has to be repeated over a few times. 

DISEASES OF THE EUSTACHIAN TUBE. 

This tube, by which the tympanum communicates with the 
pharynx, is from one and a half to two inches long ; composed 
partly of bone, partly of fibrocartilaginous tissue, and covered 
with mucous membrane. It affords an entrance for air into 
the inner ear, or tympanum, and an exit for mucus. 

(1.) Obstruction of the Tube. — Permanent obstruction is 
generally the result of inflammation ; a local irritation must 
precede the effusion of lymph, thickening, and obliteration, or 
filling up of the tube ; obstruction produces exhaustion of air 
in the tympanic cavity, consequently there is a pressure inwards 
of the membrana tympani, a forcing together of the chain of 
bones, pressure on contents of labyrinth, and deafness. 

Causes. — Inflammation or irritation ; especially affections in 
tvhich micro-organisms are present, such as chronic catarrh, 
mumps, tonsillitis, bronchitis, asthma — diseases in which the 
amoeba are present, which worm their way up this tube, and 
cause thickening of its mucous membrane, stricture, or a de- 
posit of lymph at tympanic opening, or exostosis of its walls. 
In boiler-makers, frequenters of the surf, as frequent diving in 
sea-bathing, the shock is great to the membrana tympani, but 
acts disastrously on the tube. Vacuums produced by cannon, 
nitroglycerine, etc. 

Symptoms. — Deafness is the symptom present, and in order 
to decide whether it be due to a blocking up of the tube by 
lymph, or other inflammatory products, the following might be 
tried : The entrance of air into the tympanum during act of 
deglutition can be distinctly heard by the stethoscope, an elastic 
tube eighteen inches long, having its ends tipped with ivory. 
on the principle of the telephone. One end being inserted into 
the patient's ear and the other into the physician's, the patient 
is directed to swallow saliva with mouth and nose closed. If 
the tube be pervious at the moment, the patient experiences a 

52 



626 DISEASES OF THE EYE AND EAR. 

sensation of fullness in the ear ; practitioner can also detect a 
faint crackling sound, produced by slight movement of mem- 
brana tympani. When the mucous membrane of tube and 
membrana tympani are thickened, a gentle flapping sound will 
be heard instead of the crackling. If the stethoscope fail to detect 
any sound during deglutition, or if no sound be heard when a 
forcible attempt at expiration is made, with mouth and nose 
tightly closed, and if no other cause can be detected for dullness 
of hearing, then it may be presumed that the tube is closed. 
Another plan to test whether the tube is pervious or not, is by 
means of the nasal douche at an elevation of several feet; while 
stream is running up one nostril and down the other, a sudden 
closure of the open nostril causing patient at the same instant 
to hold breath firmly, will force the fluid up to the inner ear 
if open. This will be readily recognized by the neuralgic pain 
in ear. 

Treatment. — Much good can be effected by improving the 
general health, by nourishing diet, daily bathing, warm clothing, 
and a warm, equable climate. The removal of such causes as 
catarrh, asthma, bronchitis, tonsillitis, or any enlargement or 
ulceration near the faucial opening, and by placing the patient 
upon a general alterative and tonic course. This general treat- 
ment to be based upon the cause or causes giving rise to it. 

(2.) An Open Condition of the Tube.— The normal condi- 
tion of the eustachian tube is that of closure by apposition of 
its walls. It acts like a valve, which is opened by muscles of 
the palate and pharynx during deglutition. When perma- 
nently open, complaint is made of buzzing and other noises in 
the ear. Usually uneasiness about throat ; a trickling down 
from sinuses of head, common in catarrh, and ulceration of the 
fauces from diseased-germs. By getting rid of cause a cure is 
usually effected. 

Tinnitus Aurium ; or, Noises in the Ear, may be brought 
about by a great variety of causes : 

(1.) It may be due to either anaemia, or congestion of the brain, 
and thus is a symptom of a large number of diseases. 

(2.) It may be due to the action of drugs, such as quinine 
and acro-narcotics. 

(3.) To diseases of the ear, inflammation, relaxation of mem- 
brana tympanum, open eustachian tube, etc. 

(4.) Accumulation of wax in the external meatus. The wax 
can be softened by introducing warm glycerine, filling ear ; 
then stuffing with cotton-wool, and syringing out at night 
with tepid water, with ten grains of bicarbonate of potass to 
the ounce. 

Auditory Vertigo, — A condition of giddiness dependent 
on disease of the ear. There is usually associated with it, vomit- 



DISEASES OF THE EYE AND EAR. 627 

ing and physical debility ; a pale, haggard expression of the 
features, and it comes on in fits, or paroxysms. 

The ear, in some way or other, is at fault, and the centres 
suffer ; usually a lowering of health, which is the great factor 
in causing the disease ; when neither stomach nor liver is at 
fault. True, stomach vertigo is very common. Auditory ver- 
tigo is present in ear diseases, and is liable to attack persons, 
already deaf, in a variety of forms. The pneumogastric nerve 
sends a branch to the membrana tympani, so as to enable us 
to hear the dinner-bell ; and irritation from the car can be car- 
ried back so as to cause the gastric symptoms. The fifth nerve 
is also carried to the membrana tympani. 

The vast majority of cases in which vertigo of definite and 
uniform character is apparently excited by gastric disturbance, 
an auditory defect, will be discovered on careful examination. 

OTALGIA AND EARACHE. 

Neuralgia of the auditory nerve is simply the cry of a nerve 
for better and purer blood. It may be brought about by cold, 
damp, rheumatism, gout, tubercle, syphilis. 

When an attendant upon some acute disease there may be 
fever, but more generally it is unaccompanied b}^ any febrile 
disturbance. The intimate connection of the auditory nerve 
with the various nerves of the face, especially those supplying 
the upper and lower jaws, the stomach, liver, uterus, render 
ear-neuralgia common where those organs are out of gear. Ear- 
ache is thus common, as its causes are numerous and varied. 

It is easily recognized by the sharp, lancinating pain in the 
ear, very severe ; frequently also shooting through the nervous 
filaments distributed over the side of the head and face, caus- 
ing much suffering and great restlessness. 

Treatment. — If it is traced to imperfect performance of 
stomach or liver, an emetic of lobelia, and saline purge ; any 
uterine derangement, compound betin pill ; a carious tooth, ex- 
traction ; or to any special diseased germ, treat for its destruc- 
tion. In all cases, and at once, relieve pain by resting the 
head on very hot pillows of hops, or chamomile flowers, or bran, 
or salt ; or the roasted bulbs of onions ; or better still, garlic. 
In addition, if very severe, the aconite, belladonna and chloro- 
form liniment should be applied to the side of the face: cotton- 
wool, saturated with glycerine, tincture of opium and bella- 
donna in ear. During the day, aconite and belladonna in 
alternation with quinine, are true stimulants to this nerve, and 
it is well to give pretty large doses ; at night either chloral or 
morphia, to procure a good night's rest, In the meantime, 
treat the case according to the cause, with alteratives and 
tonics ; and bear in mind that in this painful nerve-cry, that 



628 DISEASES OF THE EYE AND EAR. 

brain-food, or nerve-forming diet, is an essential and important 
element in the cure. Animal food, eggs, milk, boiled white- 
fish, oatmeal porridge, cream, and those admirable drugs, gly- 
cerite of ozone and kephaline. Nutrition is an important in- 
dication in the treatment, so as to prevent a recurrence, espe- 
cialty among the little ones. 

DEAFNESS. 

May be the result of a variety of conditions, and embraces a 
large proportion of the diseases of the ear, in which the hearing 
is defective, and associated with some nervous symptoms. In 
this category, syphilitic, tubercular diseases — inherited or ac- 
quired — of the auditory nerve, embrace a large class, as well 
as gout and rheumatism, and diseases of the stomach. Cases 
of extreme deafness, and perfect hearing, alternating, with- 
out any explainable reason or defect, are common. Besides, 
there are a class of cases due to emotional influences, which are 
very interesting, and form a distinct group by themselves. We 
often see cases where the hearing is completely lost on witness- 
ing the sudden death of a dear friend ; or upon the receipt of 
news of a painful character. Women often become deaf by 
fright — a cry of fire, or an alarm of burglars in the house ; at 
witnessing the sight of a man with his throat cut, or even on 
the receipt of good news. In such cases the hearing power 
was good up to the catastrophe, and the deafness instantaneous. 
The true explanation in such cases is the shock or hyper- 
emia of the brain, or medulla, at the origin of the auditory 
nerve. Then there is the often either impaired or total loss of 
hearing, from mumps, diphtheria and other acute diseases. In 
nervous deafness there is a certain train of symptoms that are 
excellent landmarks of the actual lesion that exists, and under 
this the deafness from fever is usually classed. 

(1.) Rheumatism of the Ear. — The structure of the mem- 
brana tympani is a very perfect, white, fibrous tissue, even 
more so than the pericardium, or lining of joints, and is very 
apt, if weakened by cold or other causes, to be relaxed, and the 
blood charged with lactic or butyric acid, giving rise to addi- 
tional irritation, effusion, thickening, deafness. 

Symptoms. — All the symptoms of rheumatism, either pre- 
ceding or co-existing, with a tenderness of the scalp, temple, 
mastoid process, jaw, and teeth of affected side. The pain in 
the ear is distressing ; tinnitus, auditory vertigo. Symptoms 
greatly aggravated at night, with acid perspiration, and urine 
loaded with uric acid. An acute attack may prove destructive 
by producing periostitis and caries. In some cases persistent 
otorrhoea results, and exfoliation of lining membrane of ear. 

Treatment. — Same as for Rheumatism,, giving quinine, and 



DISEASES OF THE EYE AND EAR. 629 

salicylate of soda heavy, with pillows of dry heat to ear. Pain 
to be relieved, at all hazards, with morphia or chloral, and 
a cure established on alteratives and tonics. Irreparable deaf- 
ness is likely to follow if not treated with great activity and 
care. 

(2.) Gout of the Ear. — A most common cause of deafness. 
May occur by itself, or during, or after an attack of gout. The 
vital forces of the ear, or rather membrana tympani, and cov- 
ering of small bones, is low, which permits of a union of uric 
acid and soda, which forms concretions on the membrana and 
small bones, and total deafness. 

Symptoms. — As the vital forces are a degree lower than in 
rheumatism, the pain in the ear is dreadful ; sets in about mid- 
night, when the electrical forces of the atmosphere and those 
of the body are low. The pain is of a tearing, twisting char- 
acter ; burning, beating noises in the ear; swelling, redness ; the 
small process of the ear bones suffer most. Often loss of con- 
sciousness, delirium and convulsions. 

Treatment. — Same as for Gout, dry heat and relief of pain. 

(3.) Nervous Deafness. — There are five different varieties : 

(1.) All that class of cases due to anaemia of brain, exhausted 
vital force by sexual excesses, masturbation, shock ; want of nu- 
trition in brain ; action of sun ; railroad jars, meagre brain-food, 
isolation, monotony, sameness, obliterating the cerebral convo- 
lutions. Best treated by removal of cause ; nourishment, brain- 
food, and remedies to give richer blood. 

(2.) Congestion. — Plethora, determination of blood to brain. 
The deafness of fevers may be due to this or anaemia. Best 
treated with foot baths, free purgation, and stimulants to nape 
of neck. 

(3.) Reflex. — Chiefly teething, stomach or liver, or bowels, or 
uterine irritation, or masturbation. Get rid of cause. 

(4.) Use of Drugs. — Quinine, chloral, opium, belladonna, to- 
bacco in large doses, carelessly, or indiscriminately adminis- 
tered, cause deafness. 

(5.) Organic. — Due to some organic change in nerve or brain ; 
as softening, or old age; involving the condition of senile 
atrophy. Very hopeless. 

In the first four varieties, an effort should be made at cure 
by an alterative and tonic course of treatment ; keeping in view 
that it is the brain that hears : that the auditory nerve, ear and 
appendages are simply the medium, or instrument. Ear dis- 
eases are most amenable to constitutional treatment. In the 
organic form, treatment same as for chronic inflammation of 
the brain, blisters to nape of neck, brain food, change of air, 
especially to the mountains where the atmosphere is highly 
rarefied and ozone abundant. 



630 DISEASES OF THE SKIN AND CELLULAR TISSUE. 



DISEASES OF 
THE SKIN AND CELLULAR TISSUE, 



DISEASES OF THE SKIN. 

The skin, the largest gland in the body, whose function is to 
eliminate waste material, morbid matter, dead disease-germs, 
and, to a certain extent, aerate the blood, is an interesting study, 
both in its normal and morbid state. The practical nature of 
the present age is cure, as a groundwork for which we must aim 
at the removal of cause ; the regulation of the all-important 
functions of digestion, assimilation, nutrition, keeping the blood 
pure, and causing every eliminating organ, as the lungs, liver, 
bowels, kidneys, to perform their own functions. The division 
and subdivision of skin diseases are most perplexing to every 
one, still it is very difficult to lay down one that would meet 
the requirements. For therapeutical purposes, all the diseases 
could be arranged under three heads, namely : diseases depend- 
ing upon disorders of digestion and assimilation ; diseases de- 
pending upon disorders of enervation, and disorders of nutri- 
tion. But even here they blend together : altered nutrition from 
defective organization; and where the life-power of the skin is 
insufficient, congestion. Even in cases of a starved condition 
of the skin, as we have in the fish-skin disease, the mingling is 
complete ; so it is best for us, in our limited space, to follow the 
old division, as laid down in our standard works. We begin, 
then, with inflammation of the skin, or — 

EXANTHEMATA. 

In which we have the true condition of irritation, inflamma- 
tion, with redness, congestion, burning or tingling pain, and 
the reflex condition, prostration, headache, languor, debility, 
rigors, and a fever. In our old teachings, the skin was described 
as a great eliminating gland, but under modern light, we must 
qualify that statement. The skin will eliminate waste or dead 
matter, but no living poison ; it must die before it can be elimi- 
nated. The diseased germs may colonize on the skin, as in 
scarlet fever and variola, but they will peel off or desquamate; 
they are not eliminated. 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 631 

In indigestion, malassimilation, with the languor, white or 
brown coat on tongue, the normal living matter concerned in 
nutrition is degraded into the diseased germ bacteria. This 
modification or chancre of living; matter may occur in the mouth 
or stomach, and their number or abundance is in proportion 
to the amount of malassimilation present, and the lack of vital 
energy in the individual. These micro-organisms are swal- 
lowed, and find their way into the blood, on which fluid they 
live, although there is an element of repulsion in it to their exist- 
ence, and they seek weakened tissue as best suited to their nu- 
trition and growth ; so if the vital integrity of the skin is weak, 
its blood-vessels relaxed, the bacteria will aggregate together in 
its meshes, and give us an exanthemata in the form of an 
erythema, roseola, or urticaria. Some authorities think that 
those germs seek the surface to get access to free oxygen, like 
the germs of variola ; and there would seem to be some truth in 
the idea, for the eruption in both cases can be caused to disap- 
pear by the application of parasiticides, or lotions, or ointments, 
to prevent the access of free oxygen, on applying which, they 
disappear, or become quiescent and die. Keep away free oxy- 
gen, or pabulum, or food supply, and their vitality is gone, or 
they are so vitally deteriorated that they can do no more mis- 
chief. The cause, then, of this class of skin diseases is a per- 
version of nutrition, a degradation of healthy living matter. 
But if there be another species of germinal matter in the blood, 
lower, more degraded, like the syphilitic, it may contaminate 
the ordinary bacteria, and give us a special form. 

(1.) Erythema. — A redness, a blush, equally diffused through 
the skin, characterized by an efflorescence, or superficial red- 
ness in patches, irregularly circumscribed, and of variable form 
and extent. The more exposed portions of the body are its 
common seat, as face, hands, neck, shoulders. 

Causes. — Malassimilation, micro-organisms, bacteria. 

Symptoms. — Those peculiar to inflammation of skin — heat, 
redness, swelling, pain, burning, tingling. 

Varieties. — Erythema simplex, or fugax, mild, fleeting nature; 
erythema Solaris, due to heat of the sun ; erythema intertrigo, due 
to chafing ; erythema pernio, when due to frost-bite ; erythema 
circinatum, when it occurs in round, red patches, slightly raised, 
often present in acute rheumatism in the tubercular ; erythema 
Iseve, when it occurs in the lower extremities in dropsy ; eryth- 
ema nodosum, when it occurs on the legs, in round or oval raised 
patches, resembling nodes ; erythema syphilitica, when copper- 
colored, and sensibility of skin impaired. 

(2.) Roseola. — Same cause and symptoms as erythema, only 
that it occurs in patches, spots, rough, irregular, elevated, not 
diffused through the skin, with redness and fever. 



632 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

Erythema and roseola resemble scarlet fever and measles 
only in the eruption. In scarlet fever there is always sore throat 
and a strawberry tongue; whereas in erythema there is no sore 
throat, no strawberry tongue ; besides, in scarlet fever there is 
the precise number of days of incubation, of fever, and rash. 
There is also albumen in the urine, and skin peels off, which do 
not take place in erythema. In measles, there is the coryza or 
sneezing, or running at nose, the injected conjunctiva, the 
definite period of incubation, fever, rash. None of those but the 
rash present in roseola ; and its appearance, even in children 
suffering from dentition, has no regularity. 

Treatment. — Erythema and roseola are best treated with a 
gentle lobelia emetic, followed with either a warm alkaline bath, 
or alcoholic vapor-bath ; open the bowels speedily with salines, 
and repeat every two hours until moved freely ; aconite and 
compound tincture of serpentaria for fever; rest in bed, beef- 
tea, and milk, for diet. 

Locally and internally parasiticide remedies ; destroy germs, 
and tone up the digestive powers. To the skin, then, in all 
cases apply one of the following lotions, or ointments ; and if 
the lotion is selected, it must be kept continually moist; for that 
purpose it is well to change often, and keep covered with oiled 
silk : Lime-water and tincture of iodine, borax, dilute acetic 
acid, and w r ater; bicarbonate potassa, or vaseline, or ozone 
ointment; and internally, chlorate or permanganate potassa, 
sulphurous acid, compound tincture cinchona, and nitromuri- 
atic acid, or saxifraga. 

(3.) Urticaria. — Nettle-rash, characterized by the formation 
of prominent patches or wheals, sometimes white, pale, or red, 
but usually with a red roseolar ; appear suddenly, and go away 
rapidly ; they are accompanied by heat, burning, tingling pain, 
great itching, prostration, rigors, fever, with a heavily-coated 
tongue, and depraved secretions. Some cases chronic and 
stubborn. 

Probably more common among women with defective men- 
strual secretion, and occurring at the expected period; still, 
quite a large percentage are due to indigestion, malassimila- 
tion, derangement of stomach and liver; through all we trace 
the bacteria. Another class of cases may be caused by articles 
taken as food or medicine, as shell-fish, mushrooms, cucumbers, 
cheese, pastry, bad milk, nuts, bitter almonds; henbane, tur- 
pentine, nux vomica, balsam of copaiba, may induce urticaria, 
and also erythema and roseola, and the oil of copaiba regular 
papulse. Urticaria may also appear as a symptom of gout, 
rheumatism, malaria, uterine inertia, and retarded or difficult 
dentition. 

Treatment. — Emetic of lobelia ; warm alkaline or vapor- 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 633 

bath ; free action of bowels with salines ; rest in bed, warm 
room ; aconite and serpentaria for fever; if due to a dormant 
condition or inertia of the uterus, compound betin pill ; very 
plain, light,' and nutritious diet. Locally, apply warm vinegar, 
or glycerine and borax, or lime-water and tincture of iodine, 
or plain borax-water, or vaseline, or ozone ointment ; antiseptics 
internally, yeast, chlorate or permanganate, aromatic sulphuric 
acid, or with quinine, or nitromuriatic acid. 

In all cases a mild alterative and tonic course, using glyce- 
rite of ozone, ozone-water, kurchicine, cinchona and mineral 
acids, for several weeks or months. In case of special germs 
being present in the blood, as the syphilitic, general treatment 
as laid down under that head. The exanthemata are regarded 
as non-contagious ; but as they depend on the presence of a 
contagium vivum in the blood, identical in its chemical and 
microscopical character with erysipelas, w T e often see them of 
an epidemic or endemic form. 

HEMORRHAGIC. 

A haemorrhage of blooc^ into the skin may take place in a 
number of diseases, and from a variety of causes, as in scurvy, 
from a deficiency of the salts of potash in the blood; as in 
purpura, from a breaking-down of the red disks, and weakness 
of the walls of capillaries. This may take place in the follicles 
of the skin on the body in the acute form in circular dots ; or 
in the chronic form on the limbs, constituting black leg. In 
typhoid fever an effusion takes place into the follicles, consti- 
tuting petechia ; or in variola contracted from opposite and 
antagonistic races, it is often so virulent as to become black or 
haemorrhagic small-pox — a fatal type. The white race of Amer- 
ica have much to fear from the living disease-germs of both 
blood and skin, living as they do among other races, who, if 
they catch the disease, will transmit it back with a potency and 
virulence indescribable. For haemorrhage into the skin see the 
various diseases enumerated. 

VESICULJE. 

A bleb, blister; a terminating of inflammatory action in effu- 
sion, with the bacteria in the serum. 

(1.) Sudamina has very erroneously been placed among 
them. This consists of crops of small, transparent vesicles, like 
glass beads. Most common where skin is fine and delicate, as 
front of neck, chest, and inside of arms. Excessive sweating, 
either caused by the use of powerful diaphoretics, as pilocar- 
pine, or a depression of the brain so great that the normal 
contractility of the sweat glands are paralyzed so that the sweat 



634 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

forms blebs ; vesicles common in such states of nervous pros- 
tration, as phthisis and typhoid fever. 

(2.) Eczema. — Some doubt the propriety of placing eczema 
under this head, but as we have a discharge of serum taking 
place from the sebaceous ducts of skin, and superficial moist 
excoriations or patches of ulceration, covered with scabs or 
crusts, constituting a humid tetter, we shall place it here. The 
affected skin becomes red, inflamed, and stiff. It is generally 
reckoned a non-contagious skin disease, but this is also in 
doubt, for if we place the serum under the field of a microscope 
of 2500 diameters, we can readily perceive the bacteria and 
their movements, which must of necessity render it communi- 
cable. In all cases the general health suffers ; there is depres- 
sion, loss of appetite, irritability, restlessness, disturbed sleep. 
It may be acute or chronic, and occur on any part of the body, 
and there may be pruritis, or itching with tingling may be very 
decided. 

One would naturally expect that eczema would be a disease 
of the " great unwashed," or lower stratum of mankind. In- 
stead of that, it is most common among the better portion of 
society ; and its cause, in nearly all cases, can be traced to over- 
feeding, indigestion, worry, anxiety, over-work, care, and those 
great factors, gout, tuberculse. In some cases, it is closely 
identified with melituria, or sugar in the urine. 

Treatment. — The removal of cause ; relieve the portal cir- 
culation; correct dyspepsia by cinchona and acids; call the 
kidneys into activity by diuretics and haircap moss, and give 
more brain-force by administering glycerite of ozone, or keph- 
aline ; meet the gouty tendency with colchicum and quinine. 
As regards diet, limit the starchy, saccharine elements ; forbid 
malt liquors, and let animal food, eggs, milk, fresh boiled fish, 
vegetables and fruit, be the leading articles. As to local treat- 
ment, if there are crusts, scabs, or incrustations, remove them 
by poultices, and if on scalp, cut hair short, and then keep ap- 
plied some bland, soothing antiseptic ointment ; do not wash 
much, nor never keep it uncovered, as the access of free oxygen 
in the atmosphere gives it fresh growth. Any of the following 
ointments will be found of great value : Ozone ointment ; sul- 
phuric acid ointment, iodoform ointment, etc. 

To relieve the itching, if over the body, the conium bath, 
and repeat it, as it has a most efficacious action on the disease. 

Cases in which sugar is found in the urine are chiefly those 
of persons in middle life, and is generally due to over-feeding, 
both in quantity and quality. 

Besides a generous diet, attention to daily bathing, building 
up vital power, the use of compound syrup of phytolacca, syrup 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 635 

of yellow dock, with iodide of potass and tonics, as cinchona 
and mineral acids. 

(3.) Herpes. — Tetter, a contagious disease of the skin, con- 
sisting of clusters of vesicles upon inflamed patches of irregular 
size and form. Some cases run a definite course, while others 
are intractable and chronic. 

There are numerous varieties, as herpes labialis, occurring on 
the lips from a cold ; herpes preputialis occurs on the foreskin ; 
herpes vulva, on the vulva ; herpes zoster, zona, or shingles ; very 
troublesome, inflamed patches following the course of an inter- 
costal nerve, with a crop of vesicles in the patch, forming a band 
encircling one-half the body ; herpes ophthalimium, a streak of 
inflammation with vesicles following the division of the fifth 
nerve ; if the nasal branch is affected, the eyeball to which it 
supplies branches may be inflamed. It is met with in neuralgia. 

Treatment. — Same as Eczema; attention to bowels and regu- 
lation of diet. Prick vesicles and press upon the exudation a 
sponge saturated with solution of permanganate of- potass or 
borax, and then keep applied sulphuric acid ointment, weak. 
Scabs, excoriations, or inflamed patches, best treated by con- 
stant wet or moist lotions, as lime-water and tincture of iodine. 
Herpes should be treated as a contagious and infectious skin 
disease — the serum of the vesicles containing millions of bac- 
teria, and it is wrong, reckless, and exhibits great ignorance to 
apply any caustic in such cases. Nothing is to be gained by 
severe measures but a further degradation of living matter 
and a re-appearance of the disease in a more aggravated form. 
Remedies locally, sufficiently strong to destroy the bacteria ; 
lotions, or ointments ; if the latter, ozone ointment is the best, as 
it is destructive to all micro-organisms ; keep it constantly ap- 
plied ; change dressing thrice daily, destroying the cloths each 
time, and puncture any new crop as they appear. In this 
way a very rapid cure is the result — it starves it out. In all 
cases, tonics and alteratives, same as in eczema. 

In the mercurial, syphilitic, and tubercular forms of eczema 
and herpes, the treatment does not differ. In those cases a 
long-continued use of internal parasiticides. 

BULL^l. 

Under this head we have two conditions identical with eczema 
and herpes, only that the vesicles or blisters are large, ranging 
from a three-cent silver piece up to a goose egg. The serum 
and matter, or contents, consist of bacteria, vibrious, and dis- 
eased germs of syphilis and tuberculse. The only satisfactory 
explanation that can be given for the enormous size of the 
vesicles is the status of vital force : when small, as in eczema 
and herpes, vital force a little shattered ; when the size of mar- 



636 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

bles or eggs, the vital force excessively deteriorated ; constitu- 
tional powers enfeebled with the diseased germs of syphilis or 
tuberculae. 

(1.) Pemphigus. — Characterized by large round, or oval 
blisters, or vesicles, or bullae, varying in size from one-half inch 
to two or more inches in diameter, and appearing on any por- 
tion of the body. Each bleb is at first filled with clear serum, 
which soon loses its transparency and becomes puriform. 
There is usually some constitutional disturbance and fever. 

(2.) Rupia. — Is simply pemphigus, in which the serum, dis- 
eased germs and pus dry up, become flattened ; they contain a 
little fluid, which soon dries up, and concretes into dark, black 
scabs. There may or may not be inflammation around their edges 
or margins ; and they may keep secreting or accumulating dis- 
eased germs from the blood, and in this way the incrustation or 
scab may increase in size and become quite hard. Those crusts, 
after a time, may fall off, leaving deep, perforating sores, which 
may heal, or again fill up. If the case is properly appreciated, 
by a reconstruction of vital power, they heal up rapidly. They 
receive different names, according to their size, consistency, and 
tendency to eat in, as rupia simplex, when the crusts are thin, 
small, superficial ; if crusts are large and prominent, rupia 
prominens; if deep, extensive, and still penetrating, rupia escha- 
rotica. 

Treatment. — The stomach, bowels, kidneys, skin, should be 
seen to ; the best of food, broiled beefsteaks, oatmeal porridge 
and cream, eggs, boiled white-fish, and every article crowded in 
to make good, rich blood ; and alteratives and tonics. The 
ozonized remedies should have the preference, as they are both 
constructive and antiseptic. 

In pemphigus it is a good plan to puncture the vesicles, not 
disturbing the cuticle, and dry up the exuded serum with anti- 
septic sponge. Either vaseline or ozone ointment should be kept 
constantly applied. 

If the bacterial odor is quite great, bandage the limbs, and 
keep the roller saturated with either a solution of permanganate 
of potass or boro-glyceride. 

PUSTULE. 

In the pustular forms of skin disease, ecthyma and impetigo, 
we have in the former effused lymph and bacteria, and in the 
latter, bacteria and pus corpuscles, like eczema, herpes, pemphi- 
gus, and bullae ; all contagious, as they are simply colonies of 
diseased germs. 

(1.) Ecthyma. — An effusion of lymph and bacteria into the 
skin, the result of malnutrition or diseased germs. It is char- 
acterized by large, round, prominent pustules, occurring on any 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 637 

part of the body, especially on head and face. Pustules usually 
distinct, seated upon a hard, inflamed base ; terminate in thick, 
dark-colored scabs, which leave superficial ulcers, followed by 
cicatrices. Sometimes it is acute, and preceded by pain and 
fever ; generally it is chronic, and is due to indigestion, torjrid 
liver, bad living, masturbation, syphilis, tubercular Common 
among young men and girls at puberty; also on the face and 
heads of badly-nourished children. If general health is much 
deteriorated by mercury, it may assume a malignant aspect. 

(2.) Impetigo. — In this we have the pustules breaking down ; 
there is a purulent discharge, which dries up and forms incrus- 
tations, from beneath which the discharge flows ; the crusts 
become thicker and larger all the time, and, tailing off, leave 
raw surfaces. The shape and size correspond with effusion in 
ecthyma, being mostly in clusters. 

The varieties amount to nothing, it is simply the disease in 
another form or shape. For example, it is called impetigo figu- 
rata,when it occurs on face; pustules arranged in oval groups 
as they burst, and form scabs ; heat and itching are intolerable ; 
often fever, and swelling of lymphatics. In tubercular children, 
suffering from malnutrition and bad food, often having the 
effusion take place on the entire scalp ; it will break down, form 
a crust or scab, covering the head like a mask, called crusted 
lactea ; when there are fever patches, and widely scattered, im- 
petigo sparsa. 

Treatment of ecthyma and impetigo should be conducted 
by attention to stomach, liver, skin ; the best of diet, as the con- 
dition points not only to diseased blood, but that fluid is poor 
in its vital elements. Bathing, hygiene, fresh air; tonics, as 
cinchona and nitromuriatic acid, or aromatic sulphuric acid, 
before meals ; and two hours after meals, an alterative, such as 
compound saxifraga ozonized, glycerite of ozone, or ozone-water. 
If the lymph has not broke down, ozone ointment ; if it has 
broke down, conium baths ; remove scab or incrustation with 
poultices, and follow with any of the following ointments : ozone 
ointment, sulphuric acid ointment, vaseline, and iodoform. 

Keep part carefully excluded from the atmosphere. Case 
rapidly recovers. 

PARASITIC! 

The term tinea, meaning a gnawing or destructive worm, is 
applied to a class of cutaneous diseases which are due to the 
presence of parasite plants ; all are contagious. 

(1.) Tinea Tonsurans. — From tonsure, to shave; because of 
the brittleness of the affected hairs. The parasite here is the 
tricophyton tonsurans, or ringworm, the sporules and myce- 
lium of which infiltrate the texture of each hair, while they 



638 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

also spread among the epithelial scales. Ringworm, no matter 
what part of the body is affected, is essentially a localized eczema, 
produced by a local cause. The local cause, in all cases, is a 
microscopic fungus, which has a peculiar affinity for the epi- 
dermic structures of man and some animals. There may be 
changes in appearance, or it may look different in one locality 
from what it does in another ; but these changes are not in the 
plant, or fungus, but in the structure of the skin in which it is 
deposited, being simply anatomical differences of structure; the 
parasite is the same in all cases. It is pre-eminently conta- 
gious ; so much so, that if an affected child be admitted in a 
school, all the other children may become similarly affected. 
If not acquired in that manner, the mycelia, or seeds, or spores, 
being so light, can be wafted great distances through the air ; 
or it can be carried by domestic animals, as cats and dogs; or 
by books, clothes, and deposited upon the skin ; and if the soil 
is favorable, that is, if vitality is low in the individual on which 
it is deposited, and if there be sufficient warmth and moisture, 
it commences to grow. If so, it passes between the horny cells 
of the epidermis, and finds its way into deeper layers, where, 
by the irritation of the more organized cells, it sets up a con- 
dition of congestion — first a red spot, then the formation of a 
ring of inflammatory papules — a true eczema ; and the circle 
widens with the growth of the fungus. As the ring spreads, 
the redness in the centre entirely disappears ; and in conse- 
quence of some obstruction or interference with the growth of 
the cells, a brawny desquamation will be observed on the sur- 
face. If the parts are hairy, the hair follicle becomes diseased 
by extension of the sporules, and its nutrition being injured, 
it dies, breaks off. Like all other vegetable plants, it may die 
if adverse conditions bear upon it, as a deficiency of warmth, 
moisture, etc. Eingworm is likely to pass into one or other of 
two conditions : it may become pustular, or it may become dry 
and squamous. 

Pustular ringworm on the scalp is a most important stage of 
the disease to recognize. It passes by the name of tinea capitis, 
and may assume either a deep or superficial form. If superfi- 
cial, the appearance is that of pustules at the mouths of the 
hair follicles, which mature and burst, and the pus of which 
is loaded with spores, comes in contact with sound skin and 
gives rise to a new and fresh crop, and in this way the entire 
head becomes a living, growing, fungous mass. As the pus 
dries, large, yellowish scabs are formed, from beneath which 
pus exudes. When the scabs are removed, some of the short, 
broken hairs come away with them, and small bald places are 
left as a result. In the deeper-seated variety the pus is formed 
in the substance of the follicle, and, as it passes to the surface 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 639 

through the neck of it, it mixes with the sebaceous matter, and 
thus becomes much thinner than ordinary pus. The effect of 
inflammation in the follicle is to cause the part to become raised 
and tender, and to have the appearance of a subcutaneous 
abscess. 

Squamous ringworm, the other variety, is the commonest and 
most chronic form of the disease. Met with in small, localized 
patches, of variable size ; sometimes isolated, in other cases 
widely diffused, spreading round the body, and exhibiting all 
forms of eczema. In some cases it will die from some adverse 
condition and disappear, leaving nothing but a dry scale. The 
localized patches are easily recognized, resembling badly exe- 
cuted tonsures, by reason of being covered with short, broken 
hairs. When widely diffused or disseminated, the true disease 
is often overlooked and treated as eczema, and when so man- 
aged will last for years. 

The class of persons most affected with ringworm are the 
unhealthy, and especially children, who are more prone to its 
attacks than adults. The character of the vitality of the skin 
and hair has much to do with it, Children or adults with black 
or dark-brown hair and dark eyes, have a thick epidermis, and 
seldom suffer from ringworm ; whereas those with light hair and 
and light-blue eyes, have a thin epidermis, take it easily, and 
suffer from it severely. 

Treatment. — The essence of sound treatment here is the de- 
struction and removal of this vegetable growth. How can 
this best be done or effected ? Mechanically and chemically. 
Of the mechanical method, it is neither justifiable nor neces- 
sary. Of the chemical, it consists in the application of such 
agents as sulphur, iodine, ozone, carbolic acid, zinc, citrine 
ointment, acetic acid — remedies antagonistic to the growth of the 
vegetable organisms known as parasiticides. Some of the 
above have some objectionable properties in exciting irritation, 
coagulating the surface, and not penetrating to the roots of the 
fungus. Now, what we want is a parasiticide, and not in the 
least possible way an irritant. Seeking for such an antiseptic, 
one that will cause no irritation, we select as a base vaseline, 
the gelatum of petrolei, which is of the consistency of butter, 
free from odor, and never becomes rancid, and is compatible 
with all known antiseptics, and is very much superior to all 
oils, fats, cerates, or ointments. Add to vaseline such anti- 
septics as thymol, menthol, borax, and we have an invaluable, 
extremely efficacious remedy. Thymol is a camphoraceous 
body, belonging to the class of aromatic compounds, and is 
present in small quantities in the oil of thyme, but chiefly 
obtained from the seeds of the ptycholis ajowam. It is a powerful 
antiseptic, being nearly ten times more efficacious in destroying 



640 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

bacteria than carbolic acid, and is not an irritant to the skin. 
Menthol, which is obtained from the Japanese peppermint, is 
nearly as powerful. Either of the two added to vaseline makes 
an efficacious application. 

In old chronic cases in adults, the fungus will have pene- 
trated away down deep in the skin; it is then necessary to add 
a drug that will carry the thymol down to the roots. No drug 
but chloroform can carry the thymol, or antiseptic, down to the 
deepest roots of the cryptogam ; so we rub in chloroform, olive 
oil, and thymol, morning and night, and keep the vaseline 
applied at other times, day and night. In this way the fungus 
is killed at its root. The ozone ointment, or the vaseline and 
thymol or menthol are admirably adapted to children. In 
addition, great attention to cleanliness. Improvement of the 
general health, by generous diet and tonics. 

(2.) Tinea Favosa. — From favus, & honeycomb. Is very 
rare ; commonly affects the scalp, in the form of small cup- 
shaped, dry, yellow crusts, each crust containing a hair in the 
centre, and resembling a honeycomb ; attended with severe 
itching; hairs become brittle and fall out; crusts have a mouldy 
and offensive odor, and are often surrounded with lice. The 
cryptogamic parasite here is the achorion schonleini. 

(4.) Tinea Sycosis. — To become like a fig, or, barber's itch. 
The parasite is microsporon mentagraphyte, which causes in- 
flammation of the hair follicles, at the same time acquiring 
greater growth in the devitalized tissue. The growth of the 
parasite resembles the eruption of small acuminated pustules, 
which have a granulated appearance and resemble the sub- 
stance of a fig. The chin and beard are the favorite locations. 

Treatment. — In the above three forms, a general alterative 
and tonic course, with the best of diet, and attention to clean- 
liness. Before the application of the antiseptic designed to 
destroy, all hairs should either be removed or cut short, and 
poultices applied, so as to remove all scabs or incrustations, 
and then the parasiticide applied, which should be kept con- 
stantly on, day and night ; changed at least thrice daily, and 
the dressings destroyed. Any of the following will answer : 
ozone ointment, citrine ointment, iodide of sulphur ointment, 
ammoniated mercury, and sulphur ointment. Keep applied 
closely to exclude oxygen. 

(6.) Tinea Versicolor. — To change color. The microsporon 
furfur is a cryptogamic plant which inhabits the pigmentary 
gland of the Caucasian. It is of a yellow color, usually makes 
its appearance on the front of the chest or abdomen ; from 
thence, in warm weather, it will grow in beautiful mottled 
or copper-colored patches, and spread over the entire body ; 
in winter, it contracts and often disappears. In some rare 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 641 

cases the cuticle over it becomes covered with brawny scales. 
Although this gland in the white race is dormant, nevertheless 
this parasite seems to make it its habitation, and, hidden in its 
recesses below the cuticle, it is difficult to reach with antiseptics, 
unless weakened by a warm alkaline bran-bath, or Turkish 
bath, and followed with lotions of sulphurous acid, and then 
freely smeared over with ozone ointment, or menthol and vase- 
line, or chloroform, olive oil, and thymol. The clothing of 
patient should be soaked in lime-water, or weak sulphurous 
acid water, so as to destroy spores of the fungus. 

PAPULJE. 

In erythema, roseola, eczema, dependent upon mal-nutrition 
and the change of normal living matter into bacteria, and in 
erysipelas, boils, etc., we can give no satisfactory reason for the 
change or aggregation of the bacteria into such varied forms ; 
nor can we assign a reason why they take the follicles of skin, 
or why those terrible germs, syphilis and tubercula, will also 
seek the follicles and form a papula. 

(1.) Lichen. — A lichen, or papular affection of the skin, with 
minute, hard, red elevations, either distinct or scattered in 
clusters, with a tingling irritation, and slight desquamation. 
The contents of the follicle are usually bacteria, with, in some 
cases, a fungus, for both can be seen under the microscope. A 
common idea is, that it is a hair follicle, in which the inflam- 
mation takes place, into which both fungus and bacteria are 
localized ; but this is not correct, for we find follicular disease 
most frequently attacks regions of the body devoid of hair. 
The following embraces the principal forms : 

(1.) Lichen Scrofulous, or tooth rash, or red gum rash; pecu- 
liar to infants and young children, may appear on any part of 
the body. It is caused by derangement of stomach and bowels, 
and is characterized by an eruption of minute, hard, red, clus- 
tered or scattered pimples. 

(2.) Lichen Simple. — Cause, malassimilation and bacteria; 
eruption red, inflamed papulae on face, arms, legs and body. 
There is itching, tingling and fever ; in spring and fall will 
probably return. 

(3.) Lichen Pilaris, or hair lichen, appears at the roots of the 
hair in young persons, about puberty ; involves the hair sac 
and root sheath. The general cause is want of cleanliness, mal- 
nutrition, use of alcoholic drinks. 

(4.) Lichen Circumsc/riptus, or clustered lichen; patches of 
papulae with well-defined margins, and irregular circular form. 
The eruption consists of rings and small groups of papulae, 
which tend to spread at their circumference into rings, the 



53 



642 DISEASES OP THE SKIN AND CELLULAR TISSUE. 

papules forming a bright, well-defined margin, while the skin 
in centre is yellow, owing to spores of a fungus. 

(5.) Lichen Agrius, or wild lichen. Usually a severe form; 
rigors, nausea, fever, slight erythema, with the papulae upon 
the inflamed base. In a short time inflammation subsides; 
skin peels off; papulae exhibit intense itching, tingling ; their 
points become scratched or rubbed off, and cracks or fissures 
form, which are painful, and discharge a sero-purulent fluid. 

(6.) Lichen Lividus. — When the eruption has a purple, or livid 
hue, and is not accompanied with fever. 

(7.) Lichen Solaris, or prickly heat ; due to exposure to heat, 
before system has become acclimatized. 

(8.) Lichen Urticatus, or nettle lichen. Skin presents the ap- 
pearance of wheals, like those produced by bugs, gnats, mos- 
quitoes, etc. The wheals subside, and leave papulae, with itch- 
ing, pricking, tingling. 

Treatment. — Emetic ; alcoholic vapor-bath, or tepid alka- 
line bath ; salines to move the bowels ; control fever with acon- 
ite and compound serpentaria tincture. When fever abates, 
plain, nourishing food and alteratives and tonics. 

To the skin, if not too extensive, ozone ointment ; if exten- 
sive, emulsion of olive oil and thymol, or menthol, over entire 
body. Dissolve the latter in the oil by gentle heat, and apply 
thrice daily. Vaseline is also excellent. 

In the purple form, diet very rich and generous, and chiefly 
tonics. The character of our drinking water at certain seasons 
has much to do with the production of lichen. 

The mercurial, syphilitic, and tubercular forms, treated with 
special remedies laid down under said diseases. 

(2.) Prurigo. — This is a very small papular affection ; pap- 
ulae or pimples about the size of the points Or heads of pins. 
The eruption usually causes great discomfort and itching, 
although this latter symptom may not be present in any great 
degree. 

Like lichen, it is divided into a number of varieties, as pru- 
rigo mitis, the mildest form ; prurigo for micans, where the itching 
is compared to that of insects moving under the skin, as creep- 
ing of ants ; prurigo senilis, when it occurs in elderly people 
suffering from indigestion. 

Cause, in all cases, malnutrition, certain articles of diet, as 
buckwheat, salt fish, pork, sameness of food, etc., etc. 

Treatment. — Precisely the same as for eczema and lichen. 
Alteratives and tonics ; locally, alkaline baths, conium bath, 
sulphur bath. Application of vinegar, lime-water, infusion of 
conium and soda; olive oil, with menthol or thymol, morning 
and night. 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 643 

SQUAMOUS, OR SCALY. 

In the scaly skin affections, although they depend for their 
origin upon great constitutional defect, some germinal poison 
in the blood, we have, besides, to contend with altered nutrition 
of the skin, from defective organization of that structure, such 
as we have in lepra or psoriasis, where the nerve-power or life- 
power of the skin is insufficient to sustain abnormal function, 
and there is much capillary congestion, which constitutes a 
part of the disease. Again, in pitryasis and ichthyosis, with 
a starved condition of the skin, as far as nutrition is concerned, 
we have excessive exfoliation in the shape of scales. 

True Eastern leprosy is a disease unknown in any portion of 
this country. We may witness bad cases of psoriasis or lepra, 
but nothing genuine. The reason of this is probably due to 
the fact that fresh variated diet is abundant, and that there 
is no cause operating to depress the nerve vitality to such a 
low pitch ; for there can be little doubt but that terrible disease 
is due to want of proper food, to repeated attacks of malarial 
fever; diseased food, and other agencies that destroy nerve 
vitality. 

(1.) Lepra, or Psoriasis. — Some are disposed to call it lepra 
when the eruption appears on arms and legs, and psoriasis 
when it occurs on the body; a distinction uncalled for. This 
is without a doubt the most intractable of all curable diseases 
of the skin. It is a non-contagious, squamous eruption, consist- 
ing of red and scaly circular patches, of various dimensions, 
scattered over different parts of the body. Most frequently met 
with near joints, as the knee and elbow. By degrees, patches 
increase in size and number, and extend over the entire body. 
It is an affection dependent on depression of the vital forces, 
with diseased blood, and enervation of the skin. In well- 
marked cases the nails become corrugated or grooved, and there 
is iritis. Different names are applied to it, according to its 
characteristic appearance. When the patches are of moderate 
size, round, and reddish, and covered with thin, white scales, 
it is called lepra vulgaris ; when the eruption is small, white, 
and of long-standing, it is termed lepra alphoides ; when it is 
copper-colered, lepra syphilitica. 

Treatment. — Attention to appetite, bowels, and skin ; to the 
latter the bran-bath is most salutary ; diet to be very generous 
and rich ; persistent use of alteratives and tonics, watching 
their action, and changing frequently. Local remedies are not 
of much use ; still, good results are to be obtained from chryso- 
phanic acid, one drachm to the ounce of vaseline, rubbed into 
the eruption after the bath, which acts both internally and 
locally. 



644 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

(2.) Pityriasis. — Dandruff. A chronic, non-contagious, squa- 
mous inflammation of the skin of parts usually covered with 
hair ; characterized by the exfoliation of minute white scales 
or scurf in great quantity. In some cases the skin is a -pale, 
doughy, white ; in others there is redness, heat, burning ; in 
both the desquamation takes place copiously and incessantly 
for many months or years. It is either dependent on or caused 
by worry, study, nervous depression, or some malnutrition or 
blood poison. When the head is affected, it is called pityriasis 
capitis; when the skin is red and much irritation, pityriasis 
rubra; when brown or copper-colored, it may be due to the 
fungus tinea versicolor, or liver spot. 

Treatment. — Remove the worry, the nervous depression ; 
build up general health with best of diet and tonics ; general 
alteratives. The head should be washed daily with warm borax- 
water and glycerine, or conium bath, or glycerine and lime- 
water, and during the intervals of every two hours one of the 
following, to be used as a hair dressing : cantharides and lobe- 
lia, borax and glycerine. 

(3.) Ichthyosis. — Fish-skin disease. A very rare, non-con- 
tagious disease of the skin, in which the affected part looks like 
the scales of a fish. This starved condition of skin is generally 
congenital, and usually met with on the legs. On the body, 
patches of thick, hard, dry, lumbricated scales, of a dirty-gray 
color, are frequently met with. As a general rule, there is no 
pain, heat, or itching. The scales, in some cases, are large, lap- 
ping over each other, and give rise to an unsightly appearance. 

Treatment. — Alteratives and tonics, with the best of support. 
Locally, the alkaline bran-bath daily ; then drying, keeping 
the affected part covered with olive, neat's-foot, or cod-liver oil, 
week about. 

TUBERCULJE. 

Under this head we enumerate a variety of states, in which 
the germ tubercle is effused in and on the skin. 

(1.) Acne. — A chronic tubercular skin affection, the seat of 
which is in the sebaceous follicles, characterized by small, iso- 
lated pustules, with deep red bases. These pustules often sup- 
purate and burst, leaving minute and hard tumors. 

Causes. — The diathesis tubercular, and the sebaceous glands, 
overworked in the process of eliminating fatty, cheesy, or other 
matter, take on inflammation, with its result, effusion of lymph. 
In other words, they are forced to do the work of other glands, 
as the liver, skin ; besides insufficient food, functional derange- 
ment, excessive alcoholism. 

Symptoms. — There is always a torpid liver, inertia of sexual 
organs, etc., which give rise to headache, constipation, coated 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 645 

tongue, general languor, with the pimples on nose, face, back, 
or wherever sebaceous glands are numerous. It is, with pro- 
priety, divided into two kinds, acne simplex and acne indurata. 
In the former, simply inflammation, in the latter, the inflamma- 
tion has terminated in effusion of lymph, thickening induration, 
which is so common about and after puberty in both young 
men and women ; most common on nose, face ; and the second 
form, acne rosacea, which is common on the nose and cheek of 
persons who drink either alcoholic or malt liquors. The action 
of the whisky daily upon the liver retards its working faculty ; 
it fails to eliminate freely carbonaceous or fatty matter, and the 
sebaceous glands of the skin are compelled to do its work ; and 
those being most numerous on the nose and cheek, are not only 
overwrought, exhausted, but suffer from inflammation, effusion 
of lymph, hypertrophy, and enlargement, so that the nose is 
not only red, but greatly increased in size, and nodulated. 

Treatment. — In the first class of cases, the liver, skin, and 
sexual organs must be seen to : cascara to keep bowels regular; 
daily alkaline bathing ; and seminal emissions or leakages seen 
to ; masturbation prohibited ; in women, the uterine functions 
looked after. A general alterative and tonic course is indis- 
pensable. The face at night to be rubbed over with ozone oint- 
ment, and not wiped off, which will destroy the bacteria around 
the follicles. If a change is desirable, iodide of sulphur oint- 
ment. 

In acne rosacea there must be strict avoidance of all alcoholic 
drinks ; liver acted on freely with cascara ; an alterative and 
tonic course for some months ; and every night at bedtime nose 
to be encased in one or other of the following ointments : ozone, 
sulphur, muriate of ammonia, iodide of potass, iodide of sulphur. 
Or, better still, the following: lotion : take six ounces of lime- 
water, half an ounce of glycerine, the same quantity of flowers 
of sulphur, and also of the tincture of sulphur. Mix. Saturate 
lint and apply, keeping it wet. 

(2.) Lupus. — A most destructive skin disease, commencing 
in a deposit or effusion of the tubercular germ from the blood 
on the skin, generally at or near the alea of the nose, or face. 
It is like its great mother, tubercle, serpiginous in shape, and 
penetrates and grows in the perivascular spaces. 

Causes. — Tubercular ; strong tubercular diathesis ; vital force 
greatly, nay, vitally deteriorated, so much so that there is a 
true condition of human rot; so that besides the germ tubercle, 
the micrococci of the oidium albicans are in great abundance. 
Those micrococci are found in the dry nodules as well as in the 
ulcerating, and their roots spread everywhere, to skin, hair folli- 
cles, connective tissue, sweat-ducts, small vessels — luxuriant 



646 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

crops of those mycelia. Irritation is simply a local exciting 
cause. 

Symptoms. — Begins with the effusion of one or more spheri- 
cal, indolent, soft, dull-red tubercles, which dry up and scale off, 
heal up, leave a scar, and then a recurrence again and again, 
and latterly they soften and ulcerate ; nothing of a syphilitic 
or cancerous nature in or about it ; free from pain ; generally 
on face ; middle-aged most obnoxious to it ; and women its chief 
victims. When the tubercular germ is effused, dries up, be- 
comes covered with scales, peeling off and re-forming, it is called 
lupus non excedens, and this term is applied even if it spreads 
widely, superficially, so long as it does not ulcerate. When it 
ulcerates it is called lupus excedens. When this takes place, it 
is most destructive, eats rapidly; the germ burrows into the 
nose and cheek, and causes dreadful ravages. It may exist on 
different parts of the body at the same time. General health 
greatly deteriorated. 

Treatment, — The liver to be kept active with cascara ; skin 
stimulated by daily baths ; most nourishing diet ; and exercise 
in open air ; tonics, as quinine, compound cinchona, and min- 
eral acids, glycerite of ozone, and kephaline ; and alteratives, 
as plytolacca, stillingia, and iodide of potass. 

Iodine is most inimical to the germ tubercle and the micro- 
cocci of the oidium albicans ; the pure iodine, combined with 
starch, so as to prevent it irritating the stomach. The following 
is the way to prepare the iodide of starch : Take twenty-five 
grains of pure iodine, place it in a mortar, triturate, first by ad- 
ding a few drops of water to the iodine, and then gradually add 
one ounce of starch, and continue the trituration till the com- 
pound assumes a uniform blue color, so deep as to approach a 
black. It should be dried at a very gentle heat, so as to run no 
risk in driving off the iodine, and kept in a well-stoppered bottle. 
No alcohol to be added. The dose is one teaspoonful in water, 
or gruel, thrice daily, and increased if no irritation of the 
stomach is produced. Without a doubt the above is most effi- 
cacious. Glycerite of ozone ranks next, which acts in the same 
way, but has a more constructive effect on the nervous system, 
and prevents more degradation of bioplasm from taking place. 
The chloride of gold and platinum are feeble remedies in the 
destruction of germs and are of no real value in lupus. 

As long as there is no eating or ulceration, keep on the tu- 
bercle ozone ointment, and depend on constitutional treatment. 
If eating or ulceration sets in, it must be at once destroyed with 
either the chloride of chromium or the chloride of gold et soda. 
If the latter is used, it should be prepared as follows : Take 
sixty grains of chloride of gold et soda, and add to it half an 
ounce of C. P. nitric acid, and use by means of a brush ; follow 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 647 

with poultices of yeast and linseed; change frequently; wash 
with the ozone et chlorine fluid, same strength as for catarrh ; 
and, if there is any evidence of eating, follow with the gold 
caustics. The roots of the germs often penetrate in every direc- 
tion, so that it is impossible to lay down rules for the caustic. 
When a good healthy sore is established, heal with ozone oint- 
ment or black salve ; continue treatment some months after 
case is well. Another method of treatment consists in scraping 
the tubercular germ off the skin with a sharp spoon, dressing 
with finely-powdered iodoform, keep dry with pressure. This 
is pretty successful, as the iodoform penetrates deep to the roots 
of the tubercle. 

(3.) Keloid. — Consists of flat, tender, leathery excrescences 
on the skin, one or two inches in diameter, or in vertical streaks 
elevated above the skin. They have a great resemblance to the 
cicatrix of a burn, and often form on cicatrices. There may be 
only one, or several, or a large patch on skin of forehead, breast, 
arms, or any part of the surface. They come slowly, rarely 
ulcerate, remain an indefinite period, and in some cases dis- 
appear spontaneously, merely leaving a cicatrix. 

Same treatment as for lupus. 

(4.) Elephantiasis. — So-called, because in the hypertrophy 
that takes place, the skin assumes the appearance of that of an 
elephant. There is usually great hardness severe pain, and 
thickening. There is always great swelling and induration of 
the true skin and derma, and involves the areolar tissue, caus- 
ing great deformity. Usually attacks the lower extremities, 
the swelling being so great that the limb is nearly double its 
usual size. It often attacks the scrotum. 

The treatment for lupus may be tried, but, as a rule, no 
remedies of any avail. 

(5.) Molluscum. — A rare form of skin disease, consisting of 
small tumors formed by an enlarged sebaceous gland. Have 
a depressed spot in their centre; vary in size from a pea to a 
pigeon's egg; of a brown color, with a broad base or narrow 
pedicle ; said to be contagious ; common in infants and chil- 
dren. If pedicle is narrow, they can be snipped off. Alterative 
treatment. 

(6.) Frambasia. — Without any precursory symptoms; skin 
of face, scalp, axillae, or genital organs are covered with small 
dusky red spots, which gradually become converted into large 
tubercles, isolated at summits, but collected together at bases, 
and resembling strawberries or mulberries in color and form ; 
tubercles generally hard, covered with dry scales, and some- 
times inflamed. If inflammation spreads, ulceration sets in ; 
a yellow sanious discharge resulting, which forms scabs. Dis- 
ease continues for years. 



648 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

(7.) Vitiligo. — A veal-like appearance of the skin, slightly- 
raised and hard. It may occur in patches, or in isolated tubercles. 

(8.) Leucoderma. — In which patches of the skin is rendered 
white. It is a disease of the pigmentary gland, and common 
among races who have an active pigmentary structure as the 
negro. 

BURNS, SCALDS. 

The degree of heat that can be borne by the human body 
without causing injury, depends very much upon the medium 
through which it is applied, as well as the organization of the 
individual. The degree of partial death inflicted upon the 
body, may be embraced under three grades, as erythema, vesi- 
cation, ulceration. 

The danger of burns depends a good deal on their intensity; 
the extent of surface injured; the degree of disorganization; 
the importance of the part, the age, and power of vital resist- 
ance of the patient. 

Symptoms. — There is the shock ; state of prostration or 
collapse, which is often dangerous. The pallor, coldness, sigh- 
ing respiration, shivering, feebleness of pulse, and other indi- 
cations of imperfect reaction and exhaustion, followed by fever 
with congestion or effusion in or upon brain, lungs, bowels ; or 
it may be reflex, and produce spasms, convulsions, or there 
may be the tedious, dragging symptom of hectic during the stage 
of cicatrization or otherwise. Besides the above, the arrest of 
the insensible perspiration of skin naturally gives rise to a ten- 
dency to serous effusion in one or all of the three great cavi- 
ties, and if the burn partakes of the character of a blister, there 
are grave changes that take place in the blood, especially if 
the blister is extensive. The serum in the blister is found not 
to be water from the blood, but rich fibrinous liquor sanguinis 
— and this exudation of blood plasm causes the blood to be 
thicker, more concentrated, and its relative proportions of cor- 
puscles and plasma modified to even a fatal extent. This con- 
centration of the blood reduces the blood pressure, and retards 
the flow of lymph, and interferes with the general nutrition of 
the part. 

Treatment. — The first point is to bring about reaction by 
diffusible stimulants and artificial heat to the extremities. 
After reaction, open bowels with castor oil, or cascara. If 
reaction is imperfect then administer aconite and serpentaria 
for fever. If there are reflex symptoms, as spasm, antispas- 
modics by mouth and rectum, followed by bromide of potass 
and calabar bean. Pain must be relieved with hyoscyamus and 
opium. Repeat until comfortable. Any congestion of brain, 
lungs, bowels, to be treated on general principles. If tonics 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 649 

are required, let them be cinchona and ammonia. Give plenty 
of fluid nourishment, as milk, beef tea, raw eggs, juice of raw 
beef, or raw beef extracts. In all cases relieve pain and ner- 
vous irritability. 

Locally, to burns, nothing can excel the carbolic acid and 
olive oil ; one ounce of the acid to six or ten of the oil, accord- 
ing to age and thickness of skin. It stimulates, destroys 
micro-organism, and aids healing; saturate lint and apply. 
Any application that will exclude air from the injured surface 
should be applied until this is procured ; as molasses, lard, and 
flour, vinegar or starch, and white oxide of zinc and oil. In 
burns of the second degree (blisters) do not puncture nor in- 
terfere with the cuticle. The great danger of burns in this stage 
is due to the amount of liquor sanguinis in the blister, and 
death is due to the blood changes so induced in that fluid. This, 
of course, is best remedied by the juice of meat. The dressing 
in all cases should be changed thrice daily, and precautions 
taken against deformity. 

CHILBLAIN OR FROST-BITE. 

The degree of cold that can be borne by the human body 
before freezing depends a good deal on the medium through 
which it is applied, (dry or moist), and the power of vital re- 
sistance in the individual. The exposed portions, as nose, ears, 
hands, feet, are most obnoxious to it, chiefly on account of 
their feeble circulation; and the feet are peculiarly prone to 
frost-bite, if sweaty or damp. This is one reason why it is 
so common in hired girls, who sleep in attics, and mostly sleep 
with their damp stockings on. A chilblain may be defined to 
be a subacute inflammatory swelling, due to cold, and the pre- 
mature restoration of the circulation by heat. 

Symptoms, — Burning, tingling, throbbing in the affected 
part, with swelling, redness, and itching. There may be vesi- 
cation or ulceration and sloughing, in all respects similar to a 
burn. 

Treatment. — Frozen parts to be thawed gradually by rub- 
bing with snow, or ice, in a cold room, without fire, and stim- 
ulants administered internally so as to get them to thaw from 
within outwards; and for some time the parts should not be 
exposed to heat. The carbolic acid and olive oil, same as in 
burns, may be used here with with good results ; or ozone oint- 
ment, black salve, or lime liniment. 

To prevent frost-bite, a high standard of health ; very nour- 
ishing food ; tonics ; fire in bed-rooms ; avoid wearing damp 
stockings, either during day or night ; tight shoes ; and proper 
protection or covering for exposed parts. Our highly oxygen- 
ized, 'dry atmosphere, with its crispy feel, is not nearly so pro- 



650 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

ductive of frost-bite below 0° as that which is humid and moist, 
with the oxygen greatly diminished. 

BOILS, OR CARBUNCLES. 

A boil is an oil-gland of the skin that has become filled with 
lymph, loaded with the micro-organism bacteria. The cause 
is malnutrition, derangement of stomach and bowels, and a 
degradation of normal living matter into bacteria, which pass 
into the blood and find their way into the oil-glands of the skin, 
probably in search of free oxygen. The cause of the malassimi- 
lation may be overcrowding, bad ventilation, filth, bad diet, as 
pork, meagre, or insufficient or sameness of food, indeed, any- 
thing that depresses the stomach. 

Symptoms. — Brown-coated tongue; nausea; loathing of food; 
constipation ; fetid breath ; heats and colds ; fever, with head- 
ache and languor ; inflammation of an oil-gland on nape of 
neck, back, limbs, or anywhere where that class of glands are 
numerous ; gland fills up with lymph and bacteria, and resem- 
bles a sugar-loaf, apex pointing inwards, and broad base on sur- 
face ; vary in size from a pea to a large pear ; the largest are 
usually met with on back. The gland is a regular cyst or sac, 
whose lining membrane is a secreting one. By proper treat- 
ment, before lymph breaks down, they may disappear ; but if 
they progress, lymph breaks down, patient has a rigor, then 
throbbing, and suppuration goes on until either relieved by 
nature or art. In some cases there is a large crop, great con- 
stitutional disturbance, and danger ; in other cases, a solitary 
one may create quite alarming symptoms. 

Treatment. — Emetic of lobelia ; alcoholic sweat ; free action 
of bowels, with compound powder of mandrake and cream of 
tartar, followed with compound tincture cinchona and nitro- 
muriatic acid, and aromatic sulphuric acid. Continue those 
drugs right along. If case is obstinate, alteratives, with iodide 
of potass. Locally, if there is no yellow speck over boil, no 
softening or other indications of pus, and the patient is desirous 
of preventing an abscess, then destroy the bacteria in the sac, 
and cause a solvent or discutient action on the lymph by apply- 
ing either the ozonized clay or the extract of belladonna, made 
into a paste with chloroform. Change fresh every three hours, 
and keep applied with firm compression. 

If there is the slightest speck or dot of softening, such treat- 
ment must not be thought of. There are two plans that pre- 
sent themselves now. It must be borne in mind that it is a 
regular sugar-loaf cone, and that for a perfect cure, the sac, 
with its contents must be thrown off; that is the core. 

First method: Cut a hole in a piece of adhesive plaster the 
size of the boil, then warm and apply closely to the skin, hav- 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 651 

ing the base of the boil in the orifice of the plaster ; wipe dry. 
Then take a stick of caustic potassa and apply, burning down 
into the substance of boil. It is well to do it thoroughly. Then 
neutralize the action of caustic with vinegar, and poultice until 
core is thrown off, then heal with ozone ointment or black salve. 

Second plan : Make a crucial incision down through the boil, 
and divide it into four parts ; then poultice until core is thrown, 
and treat as above. It must be borne in mind that the matter 
of a boil is contagious, and liable to contaminate sound parts, 
or others ; hence all dressing should be disinfected or destroyed. 

The diet in boils should be the best, and very generous, in- 
cluding beef, mutton, poultry, eggs, milk, white-fish boiled, with 
abundance of vegetables and fruit. Numerous other very suc- 
cessful methods of treatment might be suggested, but the above 
will suffice. Any good, reliable remedy that will correct the 
indigestion and destroy bacteria, can always be used with ad- 
vantage. 

ALOPECIA, OR BALDNESS. 

Loss of hair on the scalp, or eyebrows, or pubes, may be either 
temporary or permanent. The baldness may be due to a variety 
of causes. Tinea tonsurans, or ringworm, may insidiously pro- 
duce a bald patch, and after a time the hair may grow again. 
We might see the cryptogams or we might not, or the condition 
might co-exist with baldness, dependent on cutaneous neurosis ; 
or it might depend on a lesion of nerve-function, which takes a 
form of disturbance of nutrition, of the formation, and repro- 
duction of hair. In this case there is apt to be tingling pain 
before the baldness appears, and afterwards loss of sensation in 
the patch. The diseased hairs under the microscope are atro- 
phied, and of a lighter hue than natural. It may arise from 
neuralgia, or injury to a nerve; or it may arise from general 
debility, haemorrhages, fevers, tuberculosis, syphilis. The hair 
follicles remain entire, but inactive. The above cases generally 
curable if cause can be removed. In old age, the case is diff- 
erent, because the hair follicles get destroyed, and there can be 
no more production. This supervenes upon general loss of 
power; the hair follicles participating in the general weakening 
of nutritive functions. Loss begins at crown of head, and tem- 
ples, or forehead. 

Treatment. — A general tonic course, with the removal of 
cause ; quinine, iron, hydrastin, nux pill, cinchona, and min- 
eral acids ; very nourishing food. Scalp to be washed every day, 
rubbed gently, and shower-bath. Some of the following hair 
tonics used : lobelia, blood-root, cantharides, solution of ammo- 
nia, balsam of Peru, oil of rosemary, and marjorum. All 
failing, pursue a tonic and alterative course for a few months. 



652 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

Other remedies sometimes successful : Hyperdermic injections of 
pilocarpine, one-third of a grain three times a week; or jabo- 
randi internally, has a remarkable effect on the hair follicles 
in starting a new growth of hair. It need not be administered 
oftener than three times a week. 

ULCERATION. 

This consists in the progressive softening and disintegrating 
of successive layers of the affected tissue, and is a breach of 
continuity of surface, or a chasm in the part. Its causes are 
either unrepaired injuries or inflammation. Those most liable 
to it are the debilitated, the intemperate, the mercurial, tuber- 
cular, syphilitic ; and the parts of the body most generally 
affected are those in which the circulation is languid, as the 
extremities. There are numerous varieties, designated from 
the appearances they present. 

(1.) Healthy Ulcer. — In constitutions, or parts predisposed 
to it, the slightest irritation may be sufficient to excite ulcera- 
tion. In the vigorous it requires more irritation; but when 
produced, it may be what is termed a healthy ulcer, and pre- 
sent a sore free from pain with a fine granulating surface, with 
smooth, white, milky edges, and its pus thick and creamy. A 
healthy sore is smooth, covered with a transparent pellicle, or 
scum, which is lost on the margins of the granulations. 

Treatment. — In all ulcers or breaches of continuity we must 
recognize a degradation of healthy, living matter, or diseased 
germs. In a healthy sore we find nothing but the bacteria, and 
those in very small numbers, so that it is important that all 
dressings exclude air completely, be somewhat stimulating, and 
invariably antiseptic. Vaseline, or ozone ointment, or black salve, 
should therefore be kept constantly applied, spread on fine old 
linen or lint, about one,-sixteenth of an inch thick, a little 
larger than the sore, changed twice or thrice daily. The dress- 
ing on each occasion to be fresh. Before any dressing is applied, 
the limb should be bandaged from the extremity up, leaving a 
space for the application of the ointment, and over and above 
that a few turns of the bandage. 

The limb should, if possible, be kept at rest, and in an ele- 
vated position. The constitutional treatment required here is 
tonics, cinchona, and a liberal, generous blood-forming food. 

(2.) Inflamed or Irritable Ulcer.— This term is applied to 
an ulcer when it is hot, tender, very red and painful ; bleeds 
easily, and the discharge is thin, irritating ; .in some cases foul 
and copious, and heavily loaded with bacteria. 

The cause of this is some malassimilation, perverted nutrition, 
or derangement of the general health. 

The treatment should consist in opening the bowels, correct- 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 653 

ing the malnutrition with tonics, and plain, unstimulating 
food ; in allaying pain with anodynes. After a free action of 
the bowels, the sore might be stimulated with lime-water and 
tincture of iodine lotion, or permanganate potass lotion ; which- 
ever is applied must be of sufficient strength, and kept con- 
stantly moist by a frequent application of the lotion, and a 
covering of oiled silk. It is likely this will be sufficient to 
exhaust the irritability, and reduce it to a simple ulcer. If not, 
it may be necessary to brush it over with nitric acid, poultice 
for a week, then use the lotions, and follow with vaseline or 
ozone ointment. In all cases the limb to be bandaged from 
extremity up ; rest and elevation maintained. In all cases of 
irritable ulcer, a perfect freedom from pain must be obtained, 
an active alterative and tonic course pursued, with good food. 

(3.) Indolent, or Chronic Ulcer. — Old ulcers of ten or 
twenty years standing have generally a smooth, uneven sur- 
face, of a pale ashy color, like a mucous membrane. In some 
cases it may display a crop of weak fungous granulations. The 
edges are raised, thick, white, insensible, either inverted or 
everted ; discharge scanty and thin, and contains a few bacte- 
ria. Those ulcers may remain stationary for years, or take on 
an attack of irritability, and become inflamed ; or may heal, 
and then suddenly give way. An irritation in the body exist- 
ing for years, gives rise to a cachexia, which is essentially 
tuberculaB. 

Treatment, — Before interfering at all with the ulcer, the 
patient should be placed upon a very active alterative and tonic 
treatment, with a varied diet, rich in blood elements, for a 
month or two. If the patient is feeble, the stramonium oint- 
ment and iodide of potass should be applied to the ulcer to soften 
and absorb the granulations and indurated edges. If he is 
more vigorous, the ozonized clay should be applied between fine 
muslin, and when it becomes dry re-moistened and re-applied, 
or else a fresh application. This will make quick work of de- 
stroying or softening it down, and stimulate it into activity. 
A poultice of wood-ashes, caustic potass, are valuable, but severe 
in their action, the object in view being to bring the ulcer into 
a healthy condition. When this is effected, the black salve, 
vaseline, or ozone ointment should be used as a dressing. 

If not successful, apply the irritating plaster, same size as 
the ulcer on the opposite side of the limb ; with it keep an open 
sore till the old one is thoroughly healed. This latter will heal 
readily. Above all things, push constitutional treatment and 
good food ; bandage, elevation, rest, not to be overlooked. 

(4,) Tubercular Ulcer, — These are generally met with in the 
neck, axilla, groin. They consist of an aggregation of tuber- 
cular germs in a chain of lympathics — two, three, or more ; the 



654 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

tubercles grow, first albuminous, then milky, cheesy , and latterly 
calcareous — generally form several points which excite inflam- 
mation of cellular tissue, skin, giving rise to numerous open- 
ings, through which the curdy or cheesy matter exudes. Those 
perforations communicate below with each other and form ugly 
puckered cicatrices on the neck or elsewhere, when they dis- 
charge and heal up. 

In all cases general treatment for tuberculosis. At whatever 
stage seen, the clay during the day, several days in the week ; 
black salve, ozone, or vaseline ointment at other times. If seen 
before skin breaks, the clay annihilates the germ colony. It 
should always be applied between cloths, so as to prevent gritty 
particles getting into ulcers or skin. Diet of the best. 

(5.) Varicose Ulcer. — An ulcer dependent upon a varicose 
condition of the veins of the limb. The consequent venous 
congestion weakens the already debilitated parts, and renders 
them prone to ulceration. The ulcers are generally three or 
four in number, situated above the ankle. Oval in shape, in- 
dolent in their progress, neither extensive nor deep, but at- 
tended with considerable pain of an aching character. 

Treatment. — Get the general health into good order by 
tonics and alteratives, with abundance of good food and fresh 
air. Keep bowels regular, and attend to the skin by daily 
sponging. The internal and local exhibition of the witch- 
hazel to tone up the veins ; an infusion answers the purpose. 
The patient should wear an elastic stocking or bandage during 
the day. Before it is applied in the morning, limb to be bathed 
first with soap and water ; then either tincture or infusion of 
witch-hazel applied ; sore dressed with either black salve, vase- 
line or ozone ointment ; over the dressing a piece of oiled silk ; 
then an ordinary stocking, and, above all, the elastic stocking. 
The same should be repeated in the evening, but the elastic 
stocking need not be kept on during night, unless case is a very 
bad one. Infusion of oak bark, alcohol, and salt, and other 
remedies are of no importance when we have the witch-hazel. 

(6.) Fistulous Ulcer, — Consists of a tube or narrow chan- 
nel, lined by a false membrane, which is a secreting membrane, 
and which may, or may not, lead to a suppurating cavity. In 
old cases, the walls of the tube are dense and semi-cartilagin- 
ous. Fistula may be produced by a deep-seated abscess, not 
healed from the bottom, or by caries or necrosis of bone ; or by 
the perforation of tissue by a mechanical irritant or obstruc- 
tion. 

Treatment. — If there are several openings, or fistulas, com- 
municating with dead bone, it is folly to attempt to heal them. 
They should, if the parts permit, be run into one, so as to give 
nature as little labor as possible, in throwing off the dead bone. 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 655 

If due to the imperfect healing of an abscess from the bottom, 
it should be either slit up, or injected with a strong solution of 
iodine and iodide of potass ; or brushed over with nitric acid ; 
if in or about the rectum, treat as laid down under that head, 
(Fistula in Ano.) 

Phagedena; Sloughing, or Eating Ulcer. — A state that is 
liable to be brought about in all ulcers by the use of mercury, 
the presence of syphilis, meagre, or insufficient food, bad diet, 
filth, poor ventilation, and insanitary states. 

In addition to the ordinary bacteria of all ulcers, the oidium 
albicans, or rot, is developed on the ulcer. When a sore be- 
comes so affected, its surface becomes irregular ; in color, white, 
yellow, greenish, blackish ; the discharge is bloody, serous, pro- 
fuse or scanty, and the pain extreme ; and by and by the sore 
becomes more painful, ragged, uneven ; looks as if bitten out 
by the teeth of an animal, and is of a dusky, or livid aspect. 
There is apt to be fever and constitutional disturbance. 

Treatment. — Very active measures must be taken to prevent 
the progress of the disease. Aconite and veratrum for fever ; 
quinine, antiseptics, best of diet ; attend to bowels, skin, and 
expose antiseptics in apartment. The ulcer should at once be 
destroyed with caustic potassa, followed by vinegar, and then 
dressed with antiseptic poultices, charcoal, yeast, wild indigo, 
and then antiseptic ointments. If the case does not warrant such 
extreme measures, apply the ozonized clay for twelve hours, and 
follow with same poultice and dressing. It must be laid down 
as an imperative rule, a perfect alleviation of pain with opium 
or morphia ; for so long as we neglect this essential element 
the disease may occur again and again; the tendency to ulcer- 
ation being in direct ratio to the pain. 

(8.) Hospital Gangrene. — Is simply phagedena, produced 
by overcrowding a large number of wounded men together. 
It is slightly more aggravated, being more highly contagious 
and infectious, than the former ; and requires the same treat- 
ment, and if possible, isolation. 

(9.) Malignant Pustule (Anthrax.) — Becoming very com- 
mon, from importation of foreign wool, hides; and the opera- 
tives in such are often fatally affected. It begins as a little dark 
red spot, with stinging or pricking pain, on which a vesicle 
and then a pustule, seated on a hard, inflamed base. When 
this is opened it is found to contain a slough as black as char- 
coal, w r hich is a mass of giant bacteria. There are likely to be 
more than one, and to spread with rapidity, and the system 
become affected ; or there may be systemic poisoning, first from 
the workers breathing in air loaded with the diseased germs. 
(See Anthrax.) 



656 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

INFLAMMATION OF MATRIX OF NAILS. 

Onychia, or inflammation of the root, or. matrix of the nails, 
may arise from mechanical injuries, as contusions, spicula of 
bodies penetrating the mother of the nail, corns, etc. ; or it may 
arise from greatly broken-down states of the constitution, as in 
tuberculosis. 

Symptoms. — Pain, swelling, and suppuration at the root 
of nail or nails, and about the surrounding texture. Exuda- 
tion of sanious, or purulent discharge, on pressure of the nail ; 
ulceration ; nail becomes raised and finally detached, revealing 
a foul ulcer, with the most intense fetor. The disease-germ, 
oidium albicans, is present, — a true rot. Ulcer becomes glazed, 
irritable, eating and spreading in all directions, even down to 
the bone, when the vital forces are at a low ebb. 

Treatment. — Poultice with linseed and yeast ; wash, by drip- 
ping hot permanganate of potass lotion on the ulcer, by com- 
pressing a sponge, morning and night. Remove nail as soon as 
possible; continue cleansing sore, morning and night, with 
permanganate wash. Dress during the day with either the 
black salve, vaseline, or ozone ointment, iodoform. Place pa- 
tient upon a general course of alteratives and tonics with nour- 
ishing food, fresh air, hygiene, etc, when the difficulty can 
be traced to tubercular, glycerite of ozone especially ; if to syph- 
ilis, ozonized phytolacca and iodide of potass ; if to mercury, 
tonics and iodide of potass. 

INGROWING TOE NAIL. 

Owing to pressure and other causes, the margin of the nail 
presses into the flesh, and ulcer becomes covered with fleshy 
and sensitive granulations, which cause great suffering in walk- 
ing. 

Treatment, — The removal of pressure by well-adapted shoes 
or boots ; nails to be cut square, instead of down on inner and 
outer sides ; soak nail in warm soda-water daily ; scrape centre 
of nail very thin, and introduce a pellet of cotton wool, so as to 
raise the edge of the nail and separate it from the ulcer. The 
pellet of cotton should be saturated with black salve. 

SWEATY FEET AND HANDS. 

Burning in feet and hands is indicative of debility. Sweat- 
ing may be due to the same cause, even to paralysis of the sweat- 
glands. The very large percentage of sweaty feet, especially 
that with an odor, is due to the oil and sebaceous glands of the 
feet and hands being compelled to do the work of the liver ; 
hence it is to be regarded as a symptom of inertia or disease of 
that gland. In ale, beer, and whisky drinkers, the sweat is 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 657 

usually quite offensive, from the fact that it is pretty well loaded 
with bacteria ; the socks and shoes being, after they are worn a 
short time, sources of contagion. 

Treatment, — In nearly all cases of this kind, whether the 
secretion be acid or alkaline, the fluid of the sole of the foot is 
teeming with bacteria. The rapid development of bacteria in 
the sole, besides being due to the torpid liver, is favored by its 
location. An effective method of treatment is an avoidance of 
stimulants ; keeping liver active ; the bathing of the feet three 
times a day in borax-water ; changing the socks twice daily. 
The bacteria are found very numerous in the damp or wet socks, 
aud also in the leather of the shoe, so it is requisite every time 
the socks are removed, that they be immersed in an antiseptic- 
lotion, as the borax ; and also that the patient wear cork soles, 
and that these also be immersed over night in an antiseptic 
lotion, and another pair used the next day. The best plan is 
for the patient to have several pairs of such soles, and disinfect 
them every time they are used, so that they can be dried. In 
all cases, never use astringent washes, as they tend to make 
matters worse. Woollen socks should be worn in those cases. 

FOOT DISEASE, 

Domestic animals, particularly horses and cows, are often 
affected with fungus foot disease, a species of rot, in which is 
found the oidium albicans, the diphtheric disease-germ. Car- 
horses, in cities, during winter, where streets are salted, and 
cows kept on wet, undrained pastures, have each respectively 
the normal living matter of the hoof degraded into the diseased 
germ. It is apt to contaminate the milk, and cause diphtheria. 
Cleansing the hoof thoroughly, and washing with a solution of 
sulphate of iron or copper ; then covering with tar ; keeping the 
animal in a dry place. 

Boys who are permitted to wade round low ditches and ponds, 
or wet ground, acquire the same disease between the toes. The 
ozone ointment is sufficient, applied twice a day, with shoes and 
stockings, and an avoidance of wet places. If this disease is 
not seen to in both animals and man, it eats and burrows into 
the soft parts of the foot. Very destructive, and highly con- 
tagious. 

Besides these two common forms in man and beast, there is 
another destructive germ, called the mucedinous fungus, which 
eats its way into the small bones of the foot ; eats, and burrows, 
and forms grooves, channels, fistulas, which become filled up 
with black, fungous masses. This variety is not common in our 
country. 

As regards milch cows who have this disease, there can be 
produced the most incontrovertible evidence that the milk is 

54 



658 DISEASES OF THE SKIN AX.J CELLULAR TISSUE. 

capable of giving rise to epidemics of diphtheria. The greatest 
possible precautions should be taken when the disease is seen 
to retain and destroy the milk for a few days, as the disease is 
easily got rid of by any efficient antiseptic ; besides, animals 
with a fungus foot, walking over fresh pasture renders it unfit 
for other animals to subsist upon. 

WARTS, CORNS, ETC. 

The skin, without any condition of disease, may increase in 
length and breadth so as to form flaps or ridges. 

(1.) Warts, or Vegetations are simply an increase of the pa- 
pillae and cuticle. The commonest variety is that met with on 
the hands of children, which consists of lengthened papillse, each 
containing a vascular loop, and clothed with dry, hard cuticle. 
Another class consists of enlarged papillae, clothed with a very 
thin cuticle, which come on the inside of the thighs, perineum, 
and on the genital organs. Some are highly vascular, and 
bleed easily ; some are pale, indolent, flat ; others tall, and dis- 
charge a sour, irritating fluid. 

Treatment, — The parts should be washed several times a day 
with borax and glycerine ; and if they do not disappear, touch 
them daily with a mixture of equal parts of tincture of iron 
and muriatic acid, or chromic acid. Horny excrescences should 
be removed by the knife. 

(2.) .Moles, — Oblong patches of imperfectly organized skin, 
with black matter in its interstices. Small vascular patches 
and other congenital conditions, should be removed with chro- 
mic acid. 

(3.) Corns. — These are simply growths of thick cuticle, not 
lying on the true skin like callosities, but penetrating into it. 
They are caused by friction or pressure of tight boots or shoes. 
There are two kinds, the hard and the soft. The hard is situ- 
ated on the surface of the foot, where the cuticle can become 
dry and hard ; the soft, between the toes, where the cuticle is 
soft and spongy. 

Treatment. — Boots and shoes well adapted to the feet; feet 
to be bathed night and morning in soft water, or rendered soft 
by soda, well dried, and rubbed with glycerine. 

To remove corns without a particle of pain, and within a 
short period, take salicylic acid, thirty grains ; extract of can- 
nabis indica, five grains; collodion, half an ounce. Mix. Apply 
with a camePs-hair pencil brush thrice daily. 

Bunion. — A swelling over the metatarsal joint of the great 
toe. It is simply a bursal swelling, or thickened bursa, more 
or less inflamed and tender, with an increase of fluid. It should 
be treated by rest, alkaline fomentations, and keeping it painted 
over with collodion and tannic acid. 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 659 

Malignant Ulceration at the ball of the great toe has almost 
disappeared since heroic doses of mercury have been discarded. 
It used to be frequently seen in mercurio-syphilitic patients. 
It is ushered in with intense nocturnal pain in the ball, then 
the parts become livid or deep-red, then a slight oozing, and 
latterly, a sort of gangrenous ulcer, with foul, ragged edges, 
and of a dark-purple color. 

Treatment. — General alteratives, local antiseptics; pretty 
near the same treatment as for Syphilis. 

CHAPPED HANDS. 

Cracked, fissured, or chapped hands may be due to imperfect 
drying after washing; to the use of irritating substances, as cer- 
tain dyes, soaps, clothing, cold, certain kinds of gloves, etc. 

Treatment. — Washing hands carefully in tepid water, dry- 
ing carefully, then rubbing in glycerine, and wearing a pair of 
old kid or leather gloves. Ozone, vaseline, and white oxide of 
zinc are excellent, especially the former. An ointment of sper- 
maceti and balsam of Peru, or benzoate oxide of zinc is also 
of great efficacy, rubbed into the hand thrice daily, or simply 
applied at night, keeping hands encased in the gloves. 

SCABIES, OR ITCH. 

A contagious, troublesome skin disease, attended with great 
itching, which is increased by warmth. Commences as a pap- 
ular, vesicular, or pustular eruption ; vesicles or pustules rup- 
tured by scratching, causing excoriation ; generally met with 
on the finer portions of skin, as the inside of the fingers or 
abdomen. The cause is the acarus scabiei, a microscopical ani- 
mal parasite, which infests the human body. The female is 
much larger than the male, and, after impregnation, she bur- 
rows herself beneath the skin, and forms a furrow or ditch, in 
which she lays her eggs. The males have itinerant habits, and 
wander about the surface of the skin. In bad cases, the entire 
body may be covered. 

Treatment. — As it would be somewhat of an expensive cure 
to resort to vaseline, ozone ointment, glycerine, and oil of berg- 
amot, or the like, which are destructive to the parasite, the 
cheapest plan is to take two or three pounds of common lard, 
deprive it of its salt, and stir into it as much sulphur as it 
will hold, still retaining its properties as an ointment. The 
patient being bathed all over with an alkaline wash, into which 
a handful of lobelia has been introduced, well dried, and the 
sulphur and lard well rubbed into every part of the body except 
the head. He must be put in a clean bed, and his contami- 
nated clothes either fumigated with sulphur, or elsed washed 
with sulphurous acid water. This process is to be repeated 



660 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

every night for three or more nights in succession, on each 
occasion the body to be thoroughly washed before the appli- 
cation of sulphur and lard. The immersion of the body-linen, 
bedclothes, or ordinary clothing in water, acidulated with 
sulphurous acid, is sufficient in all cases to destroy the larvae 
and the parasite ; so is a heat of 212° F., either in boiling or 
by hot irons. There need be no detention from business ; the 
first application could be made on a Friday night, and the two 
succeeding ones on a Saturday or Sunday evening. 

LOUSINESS. 

The human body may be infected with three different kinds of 
lice : the head-house, body-louse, and crab-louse. 

Uncleanliness, insanitary states, perverted nutrition of skin, 
bad food, filth, etc., give rise to a depraved condition of skin, 
which render it a chosen pasture-field, or seat, for the hatching 
and breeding of the larvae of those parasites. The three species 
are oviparous, the eggs being known as nits ; sexes distinct ; 
young are hatched in five days, and in eighteen days are capa- 
ble of reproduction. The numbers of eggs laid are immense. 
Each of the three has its favorite location or abode. On the 
head they are very easily got rid of by daily washing and 
using vaseline or ozone ointment as a hair dressing ; on the 
body, it should be thoroughly bathed and lightly sponged with 
tincture of lobelia. The crab-louse, on pubes, axilla, eyebrows, 
may be got rid of at once, by washing thoroughly, drying 
off and damping the affected parts with a lotion of two grains 
of corrosive sublimate to an ounce of water. The stavesacre, 
or cocculus ointment, is excellent. 

To destroy the larvae on head, body, pubes, warm vinegar is 
very efficacious, applied morning and night. Bedclothing, 
and also body-linen, should be boiled and subjected to a strong 
heat with hot iron, and all due precautions taken for thorough 
destruction. 

INFLAMMATION OF CELLULAR TISSUE. 

The tissue between the skin and the muscles, called the cell- 
ular, or areolar tissue, is one of the best structures in the body 
for absorbing drugs, poisons, diseased germs. 

It is into this tissue that all hypodermic injections are intro- 
duced ; into this tissue that the bacteria and other diseased 
germs excite deep-seated inflammation ; the germs of dead 
bodies, bites of venomous reptiles, insects, and other micro- 
organism breed here with great activity. 

Symptoms, — Besides erysipelatous inflammation of the skin, 
the same condition exists in the cellular tissue, which gives rise 
not only to a burning, tingling, but violent throbbing ; the 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 661 

swelling is stiff, brawny ; the absorbents become quickly in- 
volved, the nearest lymphatics implicated with doughy swell- 
ings on the chest or abdomen ; the inflammation of lymphatics 
proceeds rapidly to suppuration. There are violent rigors, a low 
type of typhoid fever, with abscesses in lungs, liver, and other 
parts. Perspiration very offensive ; stools fetid ; janndice ; stu- 
por ; delirium; difficulty of breathing ; fatal exhaustion. 

Treatment. — Active treatment of the wound by puncture, 
suction, cups ; free bleeding by incisions ; and bathing with 
hot water, followed by caustic and antiseptic poultices, and lo- 
tions of permanganate ; open lymphatics the moment swelling 
is detected ; control fever with aconite and serpentaria ; and 
above all things push antiseptics, as carbolic acid and tincture 
of iodine, or brewers' yeast in sweet milk ; and quinine, to pro- 
tect the blood discs from the action of the germ. If there are 
nausea and vomiting, an emetic of lobelia, and often cleansing 
out the bowels has a salutary action. In all other respects 
treatment similar to Typhoid Fever, affording relief from pain. 

Rheumatic inflammation of the cellular tissue is rare ; still as 
it is of the class of tissues implicated, when the blood is charged 
with lactic acid it suffers, especially on the sheaths of the 
muscles that are imbeddpd in it. In some cases it is so severe 
that the nodules of lymph can be felt isolated or adherent ; in 
other cases they are very numerous, imparting a thick, gritty 
feel to the skin. 

In all cases the general treatment for Rheumatism, a perfect 
alleviation of pain, with iodide of potassa. 

TUMORS. 

A morbid growth is a certain aggregation of living tissue, 
growing independently, excessively, and abnormally. The word 
tumor is applied to it. They seem to originate in an excess of 
certain materials in the blood, and some local irritation causes 
those materials to be exuded or thrown out. "What the consti- 
tutional defect is, is unknown. They constitute a local error of 
formation, and they are identical with certain constituents of 
the body, and not incompatible with a high standard of health 
when they are simple. They may grow, or remain stationary 
for an indefinite period, and latterly suffer degeneration, or ex- 
cite inflammation, suppuration ; or they may, by their bulk, 
cause obstruction, oedema, paralysis of parts. They are devoid 
of pain. 

In another class of tumors we have the degraded bioplasm of 
our own bodies (a cancer germ) entering into them, and con- 
stituting a malignant tumor or growth, which grows by its own 
faculty of germ-elaboration, and forms fresh aggregations from 
the blood. They are called malignant because their tendency 



662 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

is to destruction and death ; and they are always painful. So we 
draw a line of demarcation between the two kinds of growths. 
Both are constitutional ; that is, the elements are in the blood, 
arising from some defect. In the simple class, the matter in excess 
in the blood is some of the normal tissues of the body, as fat, 
fibrous tissue, etc. ; whereas in the malignant class, the tumor 
is either partly or wholly made up of diseased germs, the de- 
graded living matter of the human body ; matter changed by 
adverse conditions, but living, and growing, and capable of 
independent existence for ages. 

(1.) Fatty Tumor. — This is composed of genuine fat-tissue ; 
that is, of oil-globules packed in the meshes of a natural areolar 
tissue, contained in a capsule, in which blood-vessels ramify and 
supply nutrition. They generally grow in the subcutaneous 
tissue, between the skin and the muscles. They are most fre- 
quently met with below the collar-bone, body, back, neck, inside 
of the thighs, and sometimes in or among the muscles. 

In number there is generally one ; it grows slow, may attain 
an immense bulk, seldom degenerates, is free from pain, and is 
easily recognized by its soft, lobulated, doughy feel, which never 
can be mistaken for anything else. 

If the tumor is not large, in some cases (not always), the ap- 
plication of the ozonized clay has a most marvellous effect in 
causing its dissolution. It is worthy of a trial. It may be kept 
constantly applied, if it induces no redness of the skin ; if it 
causes any redness, off and on at proper intervals. 

(2.) Fibroid Tumor. — This tumor is composed of fibrous 
tissue, identical with that of the normal tendonous structures 
of the body, arranged in bands, loops, or crescentic layers. 
Some contain more blood-vessels than others, and are pinkish 
in color, but the majority of them are destitute of vessels. This 
class of tumors is found in the womb, breast, bone ; when found 
in the breast they pass by the name of neuroma. They are firm 
to the feel, free from tenderness, smooth, oval, or lobulated ; of 
slow growth, lasting an indefinite number of years. It often 
degenerates into a stony mass, or earthy salts. 

When no larger than an orange, the application of the clay 
should be tried, keeping it steadily applied if no erythema is 
produced, and administering iodide of potass internally. That 
failing, extirpation is the only remedy. 

Besides the above, there are often found, (1.) a subcutaneous 
tumor about the size of a pea, composed of fibrous tissue, which 
affects women, and gives rise to neuralgic pains ; (2.) a fibro- 
cellular tumor, made up of bands of firm, white, fibrous tissue, 
infiltrated with serum ; (3.) fibro-plastic tumor, made up of 
fibrous tissue and lymph ; (4.) fibrous tumor, composed of fila- 
ments of fibrous tissue, with naked nuclei. 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 663 

(3.) Colloid, or Gelatinous. — A substance resembling a 
jelly, of various degrees of firmness and transparency ; is found 
in cysts of the thyroid gland, ovaries, and prostate. It is also 
found in stomach and bowels. 

(4.) Cartilaginous Tumors. — Are made up of round masses 
of cartilage, embedded in fibrous membrane. It may consist 
of various degrees of firmness, from very soft to as hard as 
cartilage. They are found on the fingers, joints, testicle, mam- 
mary glands, parotid, lungs. Their growth is slow. 

(5.) Osseous Tumors. — Are generally found in connection 
with bone, and very little difference can be detected between 
them and true bone. 

(6.) Glandular Tumors. — Are formed by the development 
of a substance resembling that of secreting glands. 

Sebaceous Tumors. — Wens, or encysted tumors, are most 
common on the head, face, and shoulders, and consist of ob- 
structed sebaceous glands, or else of erratically formed cutaneous 
cysts. In examining them with a small glass, the orifice, or 
mouth of the gland, can be seen in the centre in the form of a 
black spot or crust. They are all lined internally with a serous 
membrane, which secretes water, epidermis, scales, hairs, nails, 
oil-globules, and crystals of cholesterine, which cause the con- 
tents of the sac to resemble gruel or suet. The cyst is liable to 
accidents, which give rise to distension, suppuration, ulceration. 

Treatment. — The cause that engenders them is irritation ; 
so they never should be irritated or tampered with, and, as a 
rule, not interfered with if patient is out of health. In all 
cases they should be removed by the knife only by making an 
incision through their centre, and carefully dissecting out their 
sac, for if the smallest portion be permitted to remain, it will 
give rise to a sinus and weeping. Such tumors are common 
in the breast, prostate, parotid, and thyroid glands. As a rule, 
they are painless, not tender, moderately soft, elastic, and lobu- 
lated. Extirpation is the only cure. 

(7.) Cystic Tumors are tumors consisting of a sac containing 
solid or liquid substances. They may arise by the formation 
of definite cavities in the meshes of the areolar tissue ; by 
the dilatation and growth of obstructed gland-duct or follicles ; 
by the erratic development of nucleated cells, which become 
exaggerated into cysts. Some contain serum ; others a jelly- 
looking substance, some blood, others solid matter. 

(8,) Melanotic Tumors. — The term melanosis has been in- 
discriminately applied to all tumors or deposits containing 
black pigment matter. Pigment is of frequent occurrence in 
the human body, and consists in a deposit in the form of the 
minutest sepia-colored granules, of a dark-brown or black ap- 
pearance. 



664 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

These granules may be free, or collected into masses, with a 
cell membrane around them, or they may be added to any 
morbid growth whatever. The chemical composition is not 
accurately settled, but nearly all forms contain from eighty to 
ninety per cent, of pure carbon. The division into true and 
false is a good one — the true being an animal matter, the spu- 
rious, carbonaceous matter from without that has found its way 
into the body, or the action of ehemicals on the blood, or the 
stagnation of blood. 

(A.) True melanosis, is a diathesis or cachexia, in which large 
quantities of pigment may be deposited, or infiltrated through 
many organs in the same individual, either alone or in con- 
junction with other elements. The primary growth is likely 
to arise from some pigmentary tissue, as the choroid, or a cuta- 
neous mole. The secondary deposits are mostly found dissem- 
inated in the connective and adipose tissue, in muscles, tendons, 
mucous membrane and bone. The bones of the cranium, ribs, 
and sternum, most frequently affected. The organs which it 
generally affects are the spleen, liver, lungs, pancreas, lym- 
phatics, brain, eye, kidneys, testicles, uterus, ovaries, rectum, 
mammse. It may be associated with cancer. 

When melanotic tumors, or nodules, are on the surface their 
is no difficulty in their recognition. When deposited on or in 
internal organs, symptoms are obscure. In all cases there is 
great languor and sinking of vital power. The cachectic ap- 
pearance is a dusky, or ash-colored countenance ; emaciation, 
dropsy, night-sweats, exhaustion. 

Treatment. — Same as for Tuberculosis. 

(B.) Spurious form : inhalation of coal dust in miners, in 
bronchi and lungs. From the action of chemical agents on 
the blood, and also from the stagnation of that fluid. 

INJURIES. 

Injuries consist in the division of various tissues, without or 
with wound of the skin or other parts. 

Contusion, or bruise, is an injury inflicted by some blunt body; 
a strain is simply an undue stretching of a part. A contusion, 
or bruise, without any perforation of the skin, is likely to be 
followed by ecchymosis, a laceration of the small vessels, or 
even a large one, if deep, or if severe, it may pulpify the parts. 

When superficial, the ecchymosis of the skin appears speedily 
as a swelling of a reddish color, which speedily becomes black ; 
on third day, violet, with diffused margin or edges ; on fifth 
or sixth day, green ; on seventh or eighth day, yellow ; and 
then gradually disappears about tenth or twelfth day, sooner 
or later, according to the vital force of the patient, and intensity 
and depth of contusion. If the contusion is deeper-seated, it 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 665 

may not appear for twenty-four hours, or several days. Ecchy- 
mosis may, besides being due to injuries, be a symptom of pur- 
pura, scurvy, fevers, or of gangrene in inflammation. 

Treatment. — The object in treatment is to check extravasa- 
tion of blood, prevent inflammation, and procure obsorption of 
the effused blood. For this purpose the bruised part should be 
placed in a raised position, and if about the eye a few leeches 
might be applied, and then a poultice of Solomon seal. If it 
occurs on other parts of the body, tincture of arnica or mari- 
gold should be used. Arnica or marigold has the property of 
astringing and contracting the walls of the capillaries, and also 
promoting the absorption of the effused blood, The ordinary 
garden marigold is an unexcelled agent. This should be taken 
when in full-bloom flowers, leaves and stem, and put to steep in 
common whisky for a month, pressed well down with whisky 
enough to cover. It is much superior to arnica. Either of the 
two may be administered internally, but their effects are very 
doubtful in that way. 

WOUNDS. 

Wounds are defined to be the separation of parts by external 
violence that ought to be together or united. 

Varieties. — The incised wounds are those made with clean- 
cutting, sharp instruments ; the punctured, or those made by 
instruments whose length greatly exceeds their breadth, includ- 
ing stabs or pricks ; the lacerated, in which parts are torn; and 
the contused, or those effected by bruising. 

The incised are the least dangerous, as they are produced by 
little violence, and admit easily of repair. The punctured are 
dangerous, from their depth, and from the possibility that either 
deep vessels or viscera may be injured, or that deep-seated ex- 
travasation of blood or abscess may follow. The lacerated, or 
contused wounds, are produced with greater violence, less likely 
to heal, and more prone to slough or suppurate. They do not 
bleed so readily as incised wounds. 

Treatment. — The treatment of all wounds comprise four 
indications : (1.) to check bleeding ; (2.) to remove foreign 
bodies; (3.) to bring the divided parts into apposition and 
keep them in union, and (4.) to promote adhesion. 

Bleeding should be arrested by a raised position ; the appli- 
cation of a sponge and pressure, and if a vessel is torn it must 
be tied. 

Foreign bodies should be removed by fingers, forceps, sponge, 
water. The edges are to be brought together by stitches, one 
in the centre and the requisite number on each side ; and they 
are to be supported by adhesive strips and bandage ; and to 
promote healing, antiseptic dressing should be applied, as 



666 DISEASES OF THE SKIN AND CELLULAR TISSUE. 

carbolic acid, borax, tincture of benzoin, balsam of fir ; so as 
to destoy the micro-organism in the wound. 

Wounds of the Ear, Nose. — Wash the parts well by drop- 
ping cold water on them from a squeezed sponge ; then press 
sponge on the part ; when thoroughly cleansed, introduce as 
many stitches as are necessary to keep the edges together. Even 
if parts are completely separated they should be cleansed and 
placed accurately in their place, and stitched there, as they 
often adhere. Over and above the stitches, dress with some 
antiseptic, as balsam of fir, or compound tincture of benzoin, 
or pulverized borax ; or if parts have been completely severed, 
compound tincture of myrrh. Keep wet all the time. Over 
all some bandage. 

Wounds of the Scalp. — Cleanse thoroughly ; remove all 
foreign bodies, as dirt, sand ; shave the parts all around the 
wound, for one or more inches back ; then with lead-wire the 
edges may be stitched together. If there is no lead- wire handy 
use adhesive plaster ; over it a compress, and then a bandage. 
Stitches in scalp-wounds should never be made with linen or silk 
thread. Whatever is resorted to should latterly be followed by 
some antiseptic dressing, as balsam of fir, pulverized borax, or 
compound tincture of benzoin. 

Wounds of the Throat. — Seize and tie every bleeding ves- 
sel that can be secured. If the windpipe is only partially cut 
through, secure it with strips of adhesive plaster. If it is com- 
pletely divided, bring its edges together by stitches through 
the skin and the covering of the wind-pipe on both sides, draw- 
ing them closely together. Don't put any stitches through the 
windpipe itself. Adhesive plaster to be applied, dressed with 
some antiseptic, and the head kept well bent forward, to aid 
in the approximation of the wound. 

Wounds of the Back of Neck. — The skin and muscles of 
the back of the neck are often cut deep to the bone, by razors ; 
head drops forwards. Stitches of strong saddler's silk to be in- 
serted at close intervals ; adhesive strips, antiseptics, and head 
kept well back to favor approximation and union. 

Wounds of the Chest. — In simple, incised wounds of the 
chest their edges should be drawn together b} r adhesive plaster, 
and compresses of antiseptics applied, and kept wet, and the 
chest bandaged so as to confine the ribs; bowels opened, and 
treatment for pleurisy resorted to. If the wound ha? been oc- 
casioned by a bullet, remove it if possible, or any clothing that 
may have been carried into the wound. Dress with lotions of 
permanganate of potassa, and keep patient over on the wounded 
side, so as to drain it effectually. If a portion of lung protrudes, 
return it into its place gently. Bayonets, crowbars, etc., pene- 



DISEASES OF THE SKIN AND CELLULAR TISSUE. 667 

trating chest, to be removed, treated antiseptically, and on gen- 
eral principles. 

Wounds of the Belly. — In wounds of the abdomen, use 
stitches through the skin only, about half an inch from the 
edge of the wound ; put them close, every one-quarter or one- 
half inch ; apply between strips of plaster, and over all com- 
press, kept wet with compound tincture of benzoin, with band- 
ages over entire abdomen, followed with grain doses of opium 
every two or three hours. Treat for peritonitis ; anticipate it ; 
don't wait till it comes. 

Should any portion of the intestines protrude, wipe them 
clean and return, if they are uninjured ; but if wounded, care- 
fully remove all foreign bodies, clots of blood, and then stitch 
them up with an over and over stitch, and return, closing the 
wound in the walls as in the simple wound. Treat at once for 
peritonitis. Wounds of the liver, spleen, bladder, kidneys, are 
very serious, but not necessarily fatal. 

Wounds of Joints. — In all wounds of joints, the opening 
must be at once closed by stitches in skin, adhesive plaster, 
paraffine splint applied to secure rest; opium and veratrum 
viride given freely. Begin passive motion as soon as inflam- 
matory action ceases, say in two or three weeks. 

HAEMORRHAGE. 

Loss of blood, or the escape of blood from the blood-vessels 
in which it is naturally contained, constitutes a haemorrhage. 

It is classified in different ways ; as, for example, it is called : 

Traumatic, when due to a wound, or injury, or incision ; usu- 
ally escaping in jets, corresponding to the contractions of heart ; 
symptomatic of disease, as the bleeding from the nose in typhoid, 
and from other parts in tubercle, cancer, etc. Sometimes the 
term idiopathic is applied to it; then it is said to be a diathe- 
sis. It may be active or passive. Active haemorrhage is present 
in injuries, inflammations ; passive, when it depends on poverty 
or depreciation of the blood. They may be periodical, as in 
cases of vicarious menstruation. 

The seat of haemorrhage will depend upon the location of 
partial death or weakness. 

The general principles of treatment of all haemorrhages are : 
the circulation kept below 70 ; recumbent posture ; freedom from 
excitement; simple, nourishing, but unstimulating diet; ele- 
vated position ; and the application of stimulants, as heat, etc. 
Our best styptics are digitalis ; mineral acids, as cinchona and 
nitromuriatic acid ; quinine and aromatic sulphuric acid ; tur- 
pentine, sulphuric acid ; gallic acid. As soon as it is arrested, 
a diet rich in fibrin, as broiled beef-steak, eggs, cream, etc., 
mineral acids, cinchona. 



668 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 



DISEASES OF THE 
MUSCLES, TENDONS, BONES, AND JOINTS. 



DISEASES OF MUSCLES AND TENDONS. 

The muscles of the body act like so many ropes or pulleys 
upon the bones, for the purpose of locomotion. They rarely 
suffer from disease, unless it be those peculiar to muscular struc- 
ture, viz., atrophy and hypertrophy with fatty degeneration. 

(1.) Myositis. — Inflammation of muscular structure is rare ; 
indeed, the heart is about the only muscle in which we see at 
times inflammation thoroughly established. Circumscribed in- 
flammation in other muscles may be the result of injury, strains, 
over- exertion, disease of bones or adjoining textures. 

Symptoms. — Pain, greatly aggravated by anj movement of 
affected muscle. It becomes localized; there is heat, swelling, 
the latter distinct, resembling a tumor ; rigors and fever. It 
may terminate in effusion of lymph, thickening, induration, or 
in a breaking-down of lymph, suppuration. 

Treatment. — Control fever with aconite and serpen taria; 
relieve pain with anodynes ; apply hot alkaline poultices during 
the day, and linseed poultices, with tincture of opium, at night ; 
nourishing food ; establish convalescence upon tonics. 

(2.) Myalgia. — Stiffness, soreness, cramp, or pain in the vol- 
untary muscles of the body, may be due to various causes : for 
example, in young persons of rapid growth, persons in whom 
the bones grow faster than the muscles, the muscles and ten- 
dons become stretched, and the individual suffers from what is 
termed growing pains. These are often quite severe, and involve 
both the fleshy part of the muscles as well as its tendons, either 
the centre, or where it is inserted into the bone, or both. It is 
often due to a strain, lift, over-exertion, and involves the muscles 
of back, chest, abdomen, arms, or legs. It is also a symptom 
of a shock from cold, great nervous prostration, and is thus 
prominent in certain diseases, as fevers, inflammation, parturi- 
tion, rheumatism, scurvy, tuberculosis, cancer, chlorosis, leuco- 
cythema, dysentery, diarrhoea, prolonged lactation, exhausting 
maladies generally, and spermatorrhoea. 

Symptoms. — Pain is the chief symptom; and this in its 



DISEASES OF MUSCLES, TEXDOXS, BONES, AND JOINTS. 669 

degree and intensity bears a direct ratio to the amount of debil- 
ity that is present. Where it depends on too rapid growth of 
bone in young persons, they seldom complain of it in the morn- 
ing after a good night's rest, but comes' on after exertion, and 
gradually increases till night. In the case of the masturbator, 
or those suffering from seminal losses, pains in the morning, 
and rather wear off during the day ; whereas in case of disease, 
mostly an aching all the time. The pain in all cases, however, 
is aggravated by movement. General health in all cases is poor ; 
skin cool, pulse natural or depressed ; appetite good, clean tongue. 
In bad cases there may be night-sweats, loss of appetite, im- 
paired digestion, constipation, no vigor or energy, inability for 
work, severe mental depression. 

Treatment. — The principles of treatment will be modified 
by the cause, but all cases require good nourishing diet, as ani- 
mal food, boiled fish, oatmeal porridge, cream, raw eggs, fruit, 
vegetables in abundance ; tonics, as cinchona and mineral acids ; 
sulphate quinine and aromatic sulphuric acid ; quinine, iron, 
hydrastin, mix pill. Rest for the affected muscles, by splints or 
otherwise. Massage to be performed twice daily ; begin with 
half-an-hour treatment, and increase length to two hours, if 
patient has means to carry out treatment. In the massage 
treatment, bathe a limb with soap and water ; dry ; use dry 
hand until there is a glow of warmth; then shampoo, rub, 
knead, and otherwise manipulate with warm olive oil ; then 
another limb in same manner until the entire body is mas- 
saged. Electricity can follow if case is bad, or in a hurry to 
get well. 

(3.) Muscular Atrophy. — Muscles may waste, their fibres 
become pale, small, and inelastic. This may happen from want 
of use or exercise, or from injury to their nerves, as in fevers, 
injuries, disease, or from exposure to cold, damp, or from some 
affection of the nerve centres, the muscles of an arm or leg- 
may be smaller, as it were, by a blight. The affected member 
may become chilly, skin numb ; it becomes imperfectly nour- 
ished and decreases in bulk ; or if the patient be young, it fails 
to grow in proportion to the rest of the body. Some cases of 
atrophy may be attended with pain, especially if its nerves are 
irritated by blood poisons. 

If atrophy is not cured, it progresses on to fatty degeneration; 
that is, the muscle or muscular fibres become usurped by fat, 
an inelastic body, and their power for movement is irreparably 
lost. This can be ascertained by placing the positive pole of a 
battery near its origin, and the other near its insertion, per- 
mitting current to run pretty strong, and bring the poles within 
four inches of each other. If muscular fibre is still good, muscle 
in a few minutes will bulge up or contract at its centre between 



670 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

the two poles of the battery ; if muscular fibre has become 
usurped by fat, it will lay quiescent, and exhibit no signs of 
contractility. 

Treatment. — If the muscle has undergone fatty degenera- 
tion, no known remedy will avail ; but if there is still evidence 
of contraction between the poles of the battery, a cure can be 
effected if the cause can be removed ; so that the treatment 
embraces a general tonic course, as cinchona and mineral acids ; 
very nutritious food, stimulating frictions, shampooing, manip- 
ulation, passive exercise, electricity, baths, etc., so as to promote 
growth and keep the muscular fabrillse exercised. It may take 
months, but by constant perseverence with the massage twice 
a day it is bound to come. 

If there is pain, stiffness, with spasmodic action, muscle rigid 
as well as wasted, the cause should be removed, and the case 
managed on general principles. 

(4.) Hypertrophy of Muscles. — Muscles may suffer en- 
largement by excessive use. The muscles on the arm of a 
blacksmith or prize-fighter are enormously developed. In the 
former it is quite common for the right side to measure four or 
five inches more than the left. This' can only go on to a cer- 
tain extent — to a degree of growth in which there is an adequate 
nerve-supply ; when that limit is reached, and exercise still 
continued or persisted in, fatty tissue will begin to take the 
place of muscular fibre, and the muscle will lose its contrac- 
tility and become useless, because it has undergone fatty de- 
generation. 

The treatment is rest and alteratives. 

(5.) Rupture of Muscles and Tendons. — If a muscle is 
weak, and be subjected to violent, sudden, severe exertion, it 
may rupture, or the tendons may give way in the same manner. 

It is easily recognized by the sudden snap, and severe pain, 
and loss of the use of the ruptured muscle. 

Treatment. — It will unite like bone, nerve, or other struc- 
tures ; and to obtain this, it must be kept in apposition, by 
keeping the limb in such a position as will thoroughly relax 
the muscle ; enjoin rest. It unites by connective tissue. 

(6.) Strains. — A strain is a violent stretching of tendonous 
or ligamentous parts, with or without rupture of their fibres. 
It gives rise to severe pain, attended with faintness, great tume- 
faction in the part, with ecchymosis,with subsequent weakness 
and stiffness. If the part is not kept at rest; if the diet is very 
stimulating ; if the blood is charged with diseased germs ; or if 
it is some large joint, like the knee, there may be inflammation, 
and even fever. The most essential element in a strain is rest; 
and then some remedy to penetrate down to the diseased part, 
such as we have in the aconite, belladonna, and chloroform 



DISEASES OP MUSCLES, TENDONS, BONES, AND JOINTS. 671 

liniment, kept on sufficiently long not to vesicate the skin ; 
internally, open bowels, alleviate pain, and administer altera- 
tives. 

(7.) Acute Inflammation of Sheaths of Tendons. — Usu- 
ally caused by punctured wounds; gives rise to a severe pain, 
of a tense, throbbing character ; often leads to suppuration. In 
the management of such cases, if, after fomentations and purga- 
tives, the pain is not relieved, free incisions must be made into 
the part, same as in Felon. 

(8.) Tumors on Tendons and Ligaments, — In patients of 
a gouty diathesis, fibrous tissue, but more frequently urate of 
soda, is effused on the tendons of the small joints. (See Gout.) 

(9.) Ganglion. — This is an encysted tumor, formed by the 
sheath of a tendon, or by a new cyst developed in one of the 
fringes of the synovial sheaths, or by a bursa, whether original 
or created by friction. When recent, it is an indolent, fluctu- 
ating tumor, transparent enough to permit the light of a candle 
to be seen through it. It contains a clear synovia, thin, or 
viscid, or semi-fluid. The ordinary seat of ganglion is about 
the w T rist and fingers, still they are met with at knee, elbow, and 
other joints. They create pain, uneasiness. They are generally 
caused by strains. If they do not yield to pressure, the best 
plan, if free of the joint, is to run a seton through them, as it 
is not well to tamper with them. 

(10.) Inflammation of Bursae. — Bursae are soft cushions that 
nature has planted around the insertion of tendons in and about 
joints, to relieve the parts from pressure. They are very nu- 
merous about the knee-joint, and are often irritated by females 
kneeling on hard floors in scrubbing; then they become painful 
and enlarge. 

They need rest, fomentations, an alleviation of pain ; and if 
they do not disappear, a free incision can be made into them. 

Loose cartilages are sometimes formed in the sheaths of ten- 
dons ; they are to be removed. 

CRAMP. 

A spasmodic and involuntary contraction of one or more 
muscles, attended with rigidity and great pain ; most common 
in the muscles of the lower extremities, as the large muscle of 
the calf of the leg ; but it is very apt to affect the muscular 
fibres of internal organs, as the stomach, intestines, bladder, 
uterus, pharynx. 

The true cause is a weakness in the nerves that supply spe- 
cial muscles, and those weakened nerves cr} 7 ing for pure or 
better blood; so that disease-germs in blood, poverty of blood, 
gout, rheumatism, metals in blood, the bacteria of dyspepsia, 
the cholera germ, etc., besides, pressure on nerves not infre- 



672 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

quently causes it, as the head in labor, etc. Swimmers often 
attacked, and common cause of drowning. 

Symptoms. — The nerves of a muscle, weakened, irritated, 
cause the contraction, which gathers the muscle into a knot, 
appreciable to the touch and often to vision, when external. 
Pain is not only severe, but agonizing. The cramp, or con- 
traction, or spasm, may last a few seconds, minutes, hours, and 
leave the part tender and patient prostrated. The same nerves 
of a muscle may be affected over and over again, if its vital 
integrity is not restored ; or if due to a poison, it may affect dif- 
ferent muscles, as in cholera, where all the muscles of the body 
are in a cramp. 

Treatment. — To relieve the cramp immediately, administer 
either chloroform or the anti-spasmodic tincture, in twenty or 
thirty-drop doses, in warm boneset tea, every few minutes till 
relieved. Then search for causes, as debility, anaemia, indi- 
gestion, constipation, lead, tin, zinc, gout, rheumatism, and other 
blood diseases, and remove them with alteratives and tonics. 
Best of food ; pure air. To raise the tone of nerves, quinine, 
glycerite of kephaline, aconite, belladonna, friction, shampoo, 
massage, stimulating liniments, baths. 

DISEASES OF THE BONES. 

The bony frame-work of the body, upon which the muscles, 
arteries, veins, nerves, and skin, are attached, is a structure of 
very low organization. Nevertheless it is liable to be influenced 
by adverse conditions, its vital integrity impaired by morbid 
states of the blood, by mechanical injuries, by defects in nu- 
trition. 

Periostitis. — The coverings of bones are called the perios- 
teum, and is a fine, white, fibrous tissue, which covers the bones 
like the bark of a tree, for if it is stripped off by accident and by 
matter burrowing under it, separating it from the bone, and 
thus depriving the latter of its nutrition, the bone dies. The 
periosteum of any bone in the body may suffer a partial death, 
but it is more liable to occur on the subcutaneous aspect of those 
bones that are thinly covered, as the fingers, tibia, ulna, clavicle, 
and cranium. 

Causes. — The chief causes are the syphilitic taint, in which 
case the germs gives rise to round or oval swellings, called 
nodes; which is an infiltration of lymph and serum into the 
periosteum, or between it and the bone; tuberculse, mercury, 
rheumatism, which cause an inflammation and swelling of the 
entire length and circumference of the periosteum. It may 
also be due to injuries, punctures. 

Symptoms. — The pain in inflammation of the covering of 
the bone is sharp, lancinating, very intense ; if of the syphilitic 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 673 

type, the pain at night is unbearable ; pain still more severe if the 
bone is involved ; tenderness ; there is always some constitutional 
disturbance, greater or less. Fever, restless nights, mental de- 
pression. Rigors and throbbing indicate the formation of pus. 

Treatment, — If seen early, before the pain changes to a 
throbbing, a strenuous effort should be made to avert suppura- 
tion, for that event is equivalent to the death of the bone unless 
well managed. Fever must be controlled with aconite, and 
large doses of hyoscyams and opium, to relieve pain. Powerful 
local stimulants should be applied, such as immersion of the 
finger, or part, in water nearly at the boiling point ; the appli- 
cation of hot alcohol, or a fly blister, or the oil of lobelia; or, 
try compression — apply a bandage from the tip of the finger, 
up, as tight as can be borne, so as to control the circulation of 
blood to the part. Keep it very tight, so as to be almost un- 
bearable, and on all the time. When used, it must be before 
the throbbing has begun. Bowels and skin actively stimulated 
— the former with anti-bilious physic, the latter with Dover's 
powder. Internally, iodide of potassium, in the stillingia com- 
pound, or in alternation with white bryonia and cimicifuga. 
If rigors and throbbing have taken place, do not wait for the 
formation of an abscess, but open early, clean down to the bone, 
following with hot fomentation and poultices. An early open- 
ing, free and deep, is the only means of saving the bone from 
destruction. After matter has been evacuated, poultice, and 
then follow with black salve, ozone ointment, or vaseline, as a 
dressing ; if it is syphilitic, mercurial, tubercular, rheumatic, 
follow in w T ith the treatment necessary for each. Nodes, as a 
result of periostitis, never form, only in syphlitic poisoning. 
They may be absorbed with iodide of potass, when soft, but if 
hard, forming an ivory exostosis, they may have to be chiselled 
off. Whitlow, or felon, is simply periostitis of the periosteum 
of the fingers. 

(2.) Ostitis; or. Inflammation of Bone. — Inflammation 
of bones may arise from injuries, syphilis, tuberculse, mer- 
cury, phosphorus, rheumatism, and may be followed by effu- 
sion of lymph, breaking down of lymph, abscess, caries, or 
necrosis, or ulceration of bone. 

Symptoms. — There is a deep-seated, severe, dull pain, with 
swelling of the soft parts, rigors, and a fever ; if acute, the parts 
slowly enlarge, tenderness increases, with weight and pain. If 
it proceed to ulceration (caries or necrosis), there are rigors, and 
pain changes to a throbbing. 

The treatment embraces rest, control fever, keep bowels open, 
and skin active; local stimulants in the form of hot packs 
during the day, and the chloroform liniment at night. As 
soon as fever is controlled, iodide of potass in compound syrup 

55 



674 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

stillingia ; keep patient under it for some months. If rigors 
and a throbbing have taken place, poultice, and as soon as 
indications of pus formation are clear, free openings. If an 
opening, or several openings, have taken place, run them into 
one, so as to give nature as little work to do as possible. Ab- 
scess is rare, the condition being a breaking-down of lymph in 
the substances of the bone, giving us caries or necrosis. Either 
of these conditions can be easily detected, by a gritty or sandy 
feel of the pus. In all cases general alteratives and tonics: 
best of diet, with an excess of phosphates, as oatmeal porridge, 
cream, and boiled white-fish. 

(3.) Caries and Necrosis. — Those two. terms are used to 
signify ulceration or gangrene of bone — conditions that may 
follow inflammation, softening, molecular degeneration, and 
suppuration of surrounding soft parts. It is called caries when 
it takes place in the spongy bones, as the vertebrae, or the ends 
of the long bones ; necrosis, when it occurs in the hard, cancel- 
lated structure, or when shaft is involved in the gangrene. 
There are various forms of the latter: if the shaft of a cylin- 
drical bone dies, and is enclosed in a case of new bone, it is 
called osteo-gangrene ; exfoliation is a term applied to necrosis, 
or modification of the superficial layer, which is not encased in 
any shell of new bone. Caries attacking bones of a spongy 
texture, as the vertebrae and articular ends of bones, involves 
a less hopeful condition of repair than necrosis; whereas the 
the latter, being in the middle of the bone, leaves the two ends 
of the bone in good condition, so that repair will take place 
even under the most unfavorable circumstances, because it is 
from the two extremities that the long bones receive their 
principal nutrition. 

Symptoms. — Inflammation of bone, with suppuration and 
formation of sinuses, through which matter flows in which 
gritty or sandy particles can be detected — bony granules. In- 
troduce a probe through one of the openings; the bare, dead 
bone, or its exfoliated, or broke-down portions, can be detected. 
Discharge very fetid ; disease very chronic, and usually great 
constitutional disturbance. 

Treatment. — If the" parts admit of it, run the sinuses into 
one opening clean down to the bone, and wash out the cavity 
with four ounces of tepid water, in w T hich one drachm of caustic 
potassa has been dissolved. In caries there is nothing to hope 
for but a healing of the bone, with deformity ; whereas in ne- 
crosis, everything is to be gained by a speedy removal of dis- 
eased bone ; so the above injection should be used every day, 
if no irritation is produced, so as to soften down the diseased 
structure. Poultices of linseed; enjoin rest; push a general 
alterative and tonic course, and a most liberal diet. Any spe- 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 675 

cial blood disease at the root of the difficulty should be looked 
after by proper treatment for such. 

(4.) Atrophy of Bone. — Atrophy of bone is marked by a 
diminution of their weight, size, bulk ; involve the whole bone, 
or a part of it — one side of the bones of the face, or entire side ; 
bones may waste to a mere shell. Atrophy may be caused by 
want of nutrition, nerve-supply ; by disease, want of exercise ; 
by disease, either in the bone or adjacent parts, and morbid 
states of the blood. 

The treatment consists in removal of cause; general altera- 
tives and tonics, with local stimulation. 

(5.) Hypertrophy of Bone, — It sometimes happen* that 
one or more bones increase in length, breadth, and thickness. 
This may occur in any bone in the body. The deviation from 
ordinary nutrition, on which such enlargement depends, is 
rarely controlled by any drug. 

(6.) Exostosis. — Is a tumor formed by the irregular hyper- 
trophy of bone. Such tumors are hard, painless, and globular, 
and mostly situated on the long bones. Their structure is that 
of ordinary bone, but usually more dense and compact. In 
some cases they are porous, in others of an ivory consistence. 
They cause no pain unless they press on nerves. On the inside 
of the skull they press upon the brain, and give rise to epilepsy ; 
in the orbit they cause the eye to protrude. 

Their cause is irritation, and effusion of lymph, which be- 
comes organized into bone. 

Treatment. — If not too dense, they can often be got rid of 
by absorption, by alteratives, and by iodide of potassa, with the 
local application of the ozonized clay ; when hard, of the con- 
sistence of ivory, they can be cut down upon and chiselled off. 

(7.) Mollities Ossinm. — Osteomalacia, or softening of the 
bones. A peculiar constitutional affection, in which all or a part 
of the bones of the body may be affected by softening, which gives 
rise to distressing and remarkable deformity. Women beyond 
the age of forty are most obnoxious to it. The pelvis is some- 
times alone attacked in child-bearing women, and in some cases 
the limbs. The characteristic of the disease is the absence of 
the earthy phosphates in the bones, so that they are unusually 
flexible. 

Associated with, or probably dependent on, this condition or 
the cause of it, is very lemarkable nervous depression, the health 
hopelessly impaired, with gradual loss of flesh and strength. 
The urine is loaded with large quantities of phosphates ; severe 
pain soon follows, and spontaneous fractures are liable to take 
place. No treatment of any utility. 

In old age we meet with the opposite condition, where the 
bones have an excess of phosphates, owing to which fact they 



676 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

become extremely brittle, and are liable to give, or even break, 
upon the least violence. 

There are also other morbid states of bone, in which certain 
elements are wanting, owing to special germs being present in 
the blood, as in rickets, bow-legs, spinal curvature, etc. ; states 
in which the bones are soft, flexible, easily bent ; conditions 
due to the want of the phosphates. 

RICKETS. 

A peculiar disease of the bones, in which the osseous tissue 
looks natural, but is insufficiently impregnated with earthy 
salts ; a common condition among tubercular children, because 
their tissues, as a class, are very feeble, and suffer most when 
there happens to be a deficiency of phosphates, either in their 
diet or mother's milk. The use of bakers' bread, in which some 
vile chemical compound is introduced to whiten inferior flour 
into white bread, by which the phosphates are destroyed, is no 
food for either mother or child, as it is deficient in bone ele- 
ments. The practice of feeding children upon farinaceous 
food is very productive of rickets. The digestive juices of an 
infant's salivary glands are not mature enough to digest starch ; 
besides, starch lacks the nutrient properties of brain and bone. 
An infant fed on starch alone would die of starvation. Milk is 
the child's natural food. By the term starch we mean farina, 
corn-starch, rice-flour, and other trash manufactured to create 
disease. This kind of food interferes with the assimilation of 
bony matter. The absence of starch in milk, which nourishes 
the infants, of all mammalia, shows that it is not necessary. 
Starch-feeding is a common cause of rickets; and such a 
method of feeding is the greatest and most grievous error in 
the diet of infants. Deprive domestic animals of phosphate of 
lime, and they become rickety. Rickets are common enough 
in our country ; but with the erroneous treatment of diseases 
of dentition and cholera infantum, our offspring are cut off be- 
fore they make headway. 

Other causes might be enumerated, as, drugging mothers, 
meagre, or improper food, etc. ; and in the child, drug j, insuffi- 
cient food, absence of sunlight. 

Symptoms, — All the leading traits of a tubercular diathesis, 
dry hair, thin skin, pallor; imperfect digestion ; profuse perspir- 
ation during sleep, especially about head and face ; ends of long- 
bones enlarge ; peculiar physiogonomy ; growth stunted; head 
usually large ; forehead prominent ; fontanelles close slowly ; 
tonsils often enlarged ; chest narrow, with a prominent sternum ; 
pigeon-breasted ; spinal curvature ; pelvic deformity ; curva- 
ture of limbs ; bow legs. 

Treatment. — Same as for Taberculx. Great attention to 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 677 

general habits, diet, exercise, clothing. An abundance of good 
fresh milk, animal food, raw eggs, boiled fish, oatmeal, wheaten 
grits, and the salts of compound hypophosphites of lime, soda, 
iron in Valentine's extract of meat, bathing, sea- water, inunc- 
tion of oil, friction, shampooing. Other remedies of value are 
the milk food, glycerite of ozone, ozone water, cinchona, and 
aromatic sulphuric acid. 

Lumbar Psoas, and Iliac Abscess- — Collections of pus in 
these several cavities, or situations, are generally due to caries 
of the dorsal vertebrae in rickets. Psoas abscess invariably 
has this origin. The lumbar and iliac abscess might result 
from debility, and other causes, without spinal disease. 

Symptoms. — All the characteristics of rickets, with diseased 
spine and hectic. The quantity of pus quite great. When it 
points in the loins, generally on one side, it is known as a lum- 
bar abscess. When in the groin above Poupart's ligament, 
having travelled along the course of both psoae muscles, it is 
called a psoa abscess. When seen above Poupart's ligament 
it is called an iliac abscess. In very rare, or isolated cases, 
has the abscess burst into the abdomen. 

Treatment. — It is well to bear in mind that a permanent 
cure cannot be effected, only by anchylosis ; so that the patient 
should be placed under the same treatment as for tubercular ; 
alteratives and tonics, best of diet, inunction with oil, baths, fresh 
air, and keeping the patient in best position for anchylosis. 

The abscess should be drained of its pus every few days by 
the aspirator, carefully sealing the opening, which is extremely 
small after pus has been evacuated. It might be proper to 
mention here that inexperienced persons have often mistaken 
this form of abscess for a hernia, when in the groin, from the 
fact that it dilates when the patient coughs, diminishes, or al- 
together disappears, when he lies down ; but it must be borne 
in mind the disease of spine, the hectic, sweats, exhaustion, with 
a sense of fluctuation in the abscess, are not present in hernia. 
It is possible that both conditions might co-exist together, so 
it is well to be guarded. 

SPINA BIFIDA. 

Cleft spine: A congenital deficiency of the posterior laminar 
and spinous process of one or more vertebrae, owing to which 
there is undue distension of the membranes of cord, with 
cerebro-spinai fluid. It may occur in any of the vertebrae, but 
most common in the lumbar. 

The cause is rickets in the foetus, intensified by incompati- 
bility of temperament on the part of the parent, which is sup- 
posed to be the cause of most malformations. 

Symptoms. — A tumor, varying in size from a walnut to a 



678 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

child's head. There is fluctuation, swelling, most tense when 
the child is in erect posture. The tumor may be transparent, 
or the skin may be unaffected, or it may be congested, purple, 
or blue. If only one or more lumbar vertebrae are affected, spi- 
nal cord does not deviate from its course, and only the posterior 
spinal nerves have any connection with the sac. If the tumor 
occupy part of lumbar and part of sacral region, the cord itself 
and its nerves will almost always be found in close contact with 
the sac. Not necessarily fatal, but likely to be if there is hy- 
drocephalus, or paralysis of the bladder or rectum and lower 
extremities, or if the tumor bursts. 

Treatment. — General treatment for Rickets; avoid starch, 
and give phosphates, and improve the health in every possible 
manner. Prevent further protrusion by a compress of leather, 
gutta-percha, or painting it with collodion and tannic acid. 
Aspiration of the contents of the sac, and then compression, 
operates well. Injecting tincture of iodine, or applying a clamp 
till it sloughs off, bad, reprehensible treatment. 

The collection of cerebro-spinal fluid is first due to the want 
of the normal support of the vertebras ; its increase due to the 
irritation and unravelling of the serous fibres, causing exuda- 
tion. The collection is termed hydrorachitis. 

SPINAL CURVATURE. 

The causes of spinal curvature are an inherent delicacy or 
weakness of organization ; then peculiar avocations, causing 
the muscles on one side to become unduly developed and 
powerful, such as the habitual use of the right arm in a dress- 
maker or blacksmith; constant assumption of an unnatural 
attitude, or in hitching one shoulder in wearing a low-necked 
dress ; nurses or mothers carrying children always on one arm ; 
repeated standing on right leg, left knee bent ; a tubercular 
diathesis, in which the muscles are weak, relaxed, flabby, or 
where there is a predisposition to rickets, or a deficiency of 
earthy salts in the bones, so that there results a loss of equi- 
librium between the resistance of spinal column and weight of 
upper part of the body where the vertebrae are soft, spongy ; 
rickety diathesis strong, even amounting to inflammation, ulcer- 
ation, or caries of vertebrae or their inter-vertebral spaces. 

There are three varieties : 

Lateral curvature, the convexity being to one side, usually 
the right. 

Posterior curvature, or excurvation. 

Anterior curvature, or incurvation. 

(1.) Lateral Curvature. — This is the most common form. 
Appears chiefly in young girls from four to eighteen years of 
age, of a weak, tubercular habit, whose bones and muscles are 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 679 

deficient in vital elements ; who have been nursed and pam- 
pered, not supplied with the proper kind of food, nor had 
abundance of sunlight, or a sufficient amount of exercise in 
open air ; and where there has been an inattention to a natural 
position in standing or walking, or in wearing low-necked 
dresses, or high-heeled gaiters, corsets, and tight-lacing. Its 
recurrence is much favored by myopia, which is so prolific in 
our large school-houses from over-crowding, and forced strains 
of the eyes, which leads to a constrained position in writing, 
walking, or in ordinary duties. 

Symptoms, — One shoulder is observed to be higher than the 
other, with a growing-out of the scapula. While one shoulder 
is high, the other is unduty depressed. So one hip projects, 
while the opposite curves inwards. On an examination, the 
vertebral column is found to be curved; in double lateral cur- 
vature it is twisted like the letter 8. As the thoracic and ab- 
dominal cavities are more or less depressed, the movement of 
the lungs and heart are interfered with, and the play or peri- 
staltic action of bowels, liver, uterus, are impeded. The general 
health suffers greatly ; difficulty of breathing, dyspeptic, and 
other indications of derangement ; pain in side from pressure 
exerted on the nerves. If it is dependent directly on a rickety 
diathesis, there are the usual cachexia and distortion of the 
limbs. 

Treatment. — Removal of causes, as tight lacing, corsets, 
high-heeled shoes, low-necked dresses; abnormal posture in 
everything — in avocation, play, school ; every means to obtain 
a high standard of health should be resorted to. For this pur- 
pose, sea or country air, abundance of sunlight, daily bathing ; 
animal food, milk, raw eggs, boiled fish ; oatmeal, corn-cake ; 
very generous diet, to reach the highest standard of good health. 
When not exercising for benefit of health, rest in the recumbent 
posture in bed, with head low. Once, twice, or even thrice 
daily, strengthen the muscles and ligaments which act on ver- 
tebrae, by frictions with stimulating liniments in olive oil ; pal- 
pation, or gentle kneading or shampooing, to be performed by 
a very vital attendant; carefully devised exercise. Clothes must 
be light and warm, so that there be little weight on vertebrae. 
Unless case is bad, it can be more successfully treated without 
than with apparatus. 

A diet essentially of phosphates is the best medicine; still, 
pain must be relieved, bowels attended to, appetite stimulated, 
and a sleep of ten hours in the twenty-four induced. The com- 
pound hypophosphite of lime in beef extract is our best remedy. 

(2.) Posterior Curvature. — Chiefly affects the cervical and 
dorsal regions. It is generally caused in infancy by the fre- 
quent practice or custom of mothers and nurses in raising the 



680 DISEASES OF MUSCLES, TENDONS, BONES, AFJ JOINTS. 

child by placing the hands under the armpits, and so compress- 
ing the ribs, and forcing back the sternum and spine. Under 
this frequent custom, the muscles and ligaments which keep 
the column erect, become weakened and relaxed. In some 
cases it may depend upon rickets. 

(3.) Anterior Curvature. — Almost invariably associated 
with or dependent upon a tubercular and rickety diathesis, pro- 
ducing tubercular inflammation, caries, with destructive ulcer- 
ation of the bodies of the vertebrae, the intervertebral spaces; 
or interstitial softening and absorption of calcareous elements 
of bony tissue. As the bodies are destroyed or absorbed, the 
spines project backwards, forming an angle. As many as five 
or six of the vertebrae, with their intervertebral spaces, may be 
affected. It is more frequently met with at the middle of the 
dorsal region than elsewhere. 

The Cause, of course, is tuberculae, with rachitis ; but often 
brought into activity by falls, blows, improper support to the 
back of children, rapid distension, throwing the head back in 
fits of passion in very young children. 

Symptoms. — Intense tubercular diathesis ; weakness ; cold- 
ness; numbness of legs, with twitching and spasm. Subse- 
quently, paraplegia, with paralysis of bladder and rectum ; 
tenderness, or dull, aching pain in back; tightness of chest, 
with more or less difficulty of breathing ; rigors ; formation of 
abscess in back, the pus of which finds its way along the course 
of the psoas muscle in the groin ; exhaustion, sweats, hectic. 
Under favorable treatment, the disease gets arrested ; bones col- 
lapse; anchylosis occurs; patient recovering with incurable 
deformity. Sometimes sudden death, owing to diseased bodies 
of the vertebrae giving way and crushing the spinal cord, or from 
dislocation, with ulceration and destruction of its ligaments. 

Treatment. — General treatment for Tuberculx and Rickets as 
far as practical. Perfect rest in the horizontal position indis- 
pensably requisite ; the use of a reclining couch, so shaped as 
to keep the trunk perfectly quiet; a stiff bandage of paraffine, 
extending from the occiput to hips, to insure rest; no attempt 
to be made to rectify the deformity ; pain to be relieved ; pus 
in parts, or abscesses, to be removed by aspiration. 

For mechanical support, the best application in all cases is a 
paraffine jacket, made after the manner of the plaster of Paris 
bandage To make this jacket, take a large sheet of cotton- 
wool, long enough to reach from the nape of neck to beyond 
the buttocks. The thickness of the sheet is sufficient, but if the 
physician desires to have it thicker, he can double it or use two. 
It is then to be submerged in the liquid paraffine for five 
minutes. Have the patient in a nude condition, in the precise 
position in which it is desired to be retained ; then turn out 



DISEASED OF MUSCLES, TENDONS, BONES, AND JOINTS. 681 

the cotton, saturated with the paraffine, on a piece of oil-cloth, 
or any smooth body, oiled to prevent it adhering ; spread it out 
to its original size ; and after it has cooled sufficient so that you 
can place the back of the hand on it without inconvenience, it 
is ready for applying to the back. This cooling process will 
occupy three or four minutes. The sheet of cotton, so saturated, 
is appliid to the back, from neck to hips, and well round the 
body. Its adaptability is perfect, filling every curve or crease. 
Then apply a bandage over all, pressing the cotton firmly. 
This pressure causes a cohesion of the cotton and paraffine. 
Then have a piece of ice handy, which will cause the paraffine 
to become as hard as a block of marble. If it is desirable to 
prevent the hardening, refrain from applying the ice ; the 
paraffine in that case will take at least twenty minutes to cool. 

DISEASES OF THE ANTRUM, 

The antrum is much more frequently affected by disease than 
is generally supposed. 

(1.) Abscess of the Antrum. — Is very common, as the re- 
sult of blows on the cheek, and from decayed stumps of teeth 
in the jaw. It has been caused in new-born infants from in- 
juries during parturition. The symptoms are aching, uneasi- 
ness of the cheek, preceded by acute throbbing, pain, rigors, 
fever, followed by slow and progressive enlargement. If unre- 
lieved, there will be bulging of the cheek, extrusion of the eye, 
obstruction of the lachrymal duct, depression of the hard palate, 
loosening and dropping out of the teeth, and closure of the nos- 
tril. In some cases it will burst into the nostril or mouth. 

Treatment. — A free aperture should be made into the an- 
trum by extracting either of the molar teeth, and a trocar 
pushed up through the empty socket into the antrum. If the 
teeth are all sound, then an opening should be made through 
the membrane of the mouth, above the alveoli of the molar 
teeth, and the bone be pierced by a strong trocar. After the 
pus has been evacuated, it should be syringed out with an an- 
tiseptic wash, as borax or carbolic acid. 

(2.) Dropsy of the Antrum. — The antrum may become 
enormously distended with its own natural, clear, mucous se- 
cretion, if the aperture into the nostril be obliterated. An open- 
ing to relieve the difficulty is best made through the molar 
teeth. Its evacuation should be followed by a stimulating injec- 
tion of carbolic acid and glycerine. 

(3.) Tumors of the Antrum.— In addition to abscess and 
dropsy, the antrum is often filled up with bony matter, exosto- 
sis, and fibro-plastic tumors of the consistence and form of 
brain or liver ; often the color of the latter, and difficult to re- 
cognize from cancer. Others have the color and consistence 



682 DISEASES OP MUSCLES, TENDONS, BONES, AND JOINTS. 

of kidney. We meet with fibrous tumors, very dense and en- 
cysted tumors, and other deformities, that may be mistaken for 
enlarged antrum. 

With all diseases of the teeth and nose the antrum has much 
to do. The incessant tinkering about old stumps; filling with 
amalgam loaded with mercury, sets up irritation and effusion. 
The ignorant extraction of teeth has also much to do with it. 
Catarrh, and its diseased germ, amoeba, often block up the 
nasal opening. The trouble seems to be that when its lining 
membrane becomes irritated, that it will secrete an endless vari- 
ety of substances, which, when liquid, semi-liquid and glandular, 
are easily got rid of by an opening, stirring up the contents, and 
washing out the antrum daily with a stimulating wash. The 
kidney or liver deposits are often mistaken for cancer by the 
great pain they occasion. In all cases, besides the removal of 
contents, an alterative and tonic course. From the number of 
ignorant men entering the dental profession, it is highly prob- 
able the diseases of the antrum will be much increased. 

FRACTURE. 

By the term fracture is meant a break of bone. 

Causes. — There maybe a predisposition in the bones to give 
way, owing to disease, as atrophy, softening, or excessive brit- 
tleness of bone, due to an abscess or excess of certain constitu- 
ents. The exciting causes are either mechanical violence or 
muscular action. Mechanical violence may be direct or indi- 
rect; direct when the bone gives way at the point to which the 
violence has been applied ; indirect, when the bone gives way 
between two opposing forces. Muscular action is rarely a cause, 
unless the bones are either weak or diseased. 

Varieties. — Fractures are divided into simple and compound 
— simple when there is no laceration of the skin or soft parts ; 
compound when the bone has protruded through the skin. 
Simple fractures are divided into classes as follows : transverse, 
when the bone is broke clean across ; oblique, when broke in an 
oblique direction ; longitudinal when slit up in its length ; com- 
minuted, when broke into small fragments. Compound frac- 
tures are more dangerous than the simple because the force or 
violence necessary to cause a bone to force its way through the 
skin gives rise to a greater shock ; because there is more danger 
of a laceration of nerves and blood-vessels ; and because, under 
the tedious process of healing of broken bone, with ulceration 
of soft parts, the patient's vital forces may give out. 

Symptoms. — The symptoms of fracture are essentially three : 
Deformity, such as bending, shortening and twisting of the in- 
jured limb; preternatural mobility ; one end moving independ- 
ently of the other ; crepitus, a grating noise, heard and felt when 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 683 

the broken ends are rubbed against each other. In addition 
to those three essential symptoms, there may be pain, heat, red- 
ness, swelling, ecchymosis, helplessness, twitching, spasm of 
the muscles. 

Treatment. — The treatment is very simple, and embraces 
four indications, which, if properly carried out, patient in good 
health, no blood taint, or disease, will insure a good union of 
broken bone. 

Before attending to those four points, the patient must be 
carried to his home, or hospital, on a stretcher or ambulance, 
with both legs tied together at knee and ankle ; or, if an arm, 
tied to the body, so that there be no chance of the broken bone 
being thrust through the skin. When home, the bed on which 
he is to rest should be made as level as possible ; the patient 
laid upon it, undressed and examined, and well washed. 

(1.) The limb must be placed in such a position as will relax 
the principal muscles that cause displacement. 

(2.) The fracture must be set; that is, the broken parts must 
be adjusted in their natural position. For this purpose the 
upper end of the limb must be held firmly by an assistant; the 
lower is extended, or firmly but gradually and gently drawn in 
such a direction as to restore the limb to its proper length and 
shape, carefully manipulating any fragments with the fingers 
into their proper position. If necessary to overcome pain or 
spasm, chloroform should be administered. 

(3.) If it does not interfere with the dressing, the limb should 
be bandaged from extremity up, so as to confine muscles and 
prevent them from disturbing the fracture. 

(4.) It is always necessary to use some mechanical contrivance 
to keep the limb its proper length and shape, to keep the two 
broken ends inperfect apposition, and prevent all motion or 
movement. 

There are various contrivances and appliances, embracing 
splints, pads, sand -bags, starch and plaster of Paris rollers, 
paraffine moulds, adhesive strips, for each respective fracture. 

If vitality is good, no syphilis, nor mercury, nor tubercle, 
nor cancer-germ in blood ; if the bones are in perfect apposi- 
tion, no pain, and a very high standard of health maintained, 
the broken bones might become cemented together without any 
swelling, or lymph-callus being present — a perfect union by first 
intention; but more frequently they unite in the following 
manner : 

Repair of Bone. — When the vital forces of the patient rallies 
from the shock of the accident, nature begins to throw out lymph 
from the broken ends of the bone, the periosteum, and sur- 
rounding textures. She continues this process for a week or 
ten days. This lymph embraces the two ends of the bone and 



684 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

adjacent parts. When nature has completed the effusion, she 
begins next a process of absorption and consolidation of this 
lymph, which gradually grows less and less, firmer, and more 
substantial, so that in ordinary cases, at the end of six weeks, 
the patient may get about, with care; and at the end of four 
and a half months more, this lymph is all absorbed, the two 
ends of the bone perfectly united, even as strong as the original 
bone. The technical term for that lymph, from its first effusion 
to its ultimate absorption, is a provisional callus. It is supposed 
that that lymph is first converted into fibrous tissue, and gradu- 
ally into bone. The time of absorption and consolidation varies 
with the age, vitality, and fitness of dressing, apposition, rest, 
good nourishment, freedom from worry, etc. There are some 
bones when broken that do not unite by bone except in rare 
cases, such as all flat bones, like the skull, the neck of the thigh- 
bone, the heads of bones in joints, or bones covered by the 
synovial membrane, or lining of joints. There are numerous 
reasons for these not uniting, as they cannot be kept in appo- 
sition, or contact, or at rest ; there is no structure present to 
form a provisional callus. This is a wise provision of nature, 
for if bony matter was thrown out in joints, their mobility 
would be entirely destroyed. The shafts of the long bones are 
where perfect union can be best obtained and with exactness. 

NON-UNION AND FALSE JOINT. 

A perfect union of the broken ends of two bones may not 
take place by bone, but by ligament, or not at all; the ends of 
the bones become smoothed off, and false joint forms. 

This is liable to occur from a defect in the dressing ; from 
irritability and restlessness of the patient ; from age ; debility ; 
albuminuria; or from the presence of diseased germs in the blood, 
as tuberculse, syphilis, cancer ; or to the poison of mercury ; or if 
the patient is pregnant, or a fever comes on ; or if there is dis- 
ease in other parts ; or if there is an inadequate nerve-supply, 
meagre diet, insanitary surroundings, stimulants that deprave 
the blood ; from pain in the fracture. No fracture can unite 
by bone if pain is present. Drugs are very liable to cause it, 
especially iodide of potass. 

Treatment. — Should union not occur in the regular period, 
the best plan is to apply the paraffme dressing, which is soft, 
firm, and will keep the parts at perfect rest and perfect appo- 
sition, and in no way impede the circulation, like plaster of 
Paris or the starch roller. Should this not succeed, after six or 
eight weeks' trial, make an effort to remove the cause, if possi- 
ble, and get the health restored. Then there are various 
methods of procedure, which have the same object in view, 
namely : causing a determination of blood to the part, a molecu- 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 685 

lar excitement, a true hyperemia. This may be done by the 
two poles of a battery, applied daily ; by the irritating plaster 
over the part; by rubbing the ends of the bones against each 
other; or the fractured ends could be cut down upon, their 
ends sawed off, and treated as a compound fracture. In other 
cases holes are drilled in the bone ; ivory pegs, setons, etc., 
everything calculated to cause a determination of blood to the 
part. 

The constitutional treatment is of the greatest importance. 
Debility must be overcome, with good food, tonics ; and it is 
well to see to food that contains bone, as oatmeal porridge and 
cream, boiled fish, and even administer lime-water in milk. 

COMPOUND FRACTURE. 

A fracture with a wound, or laceration, through which the 
bone has penetrated. The greater violence necessary to cause 
this form of fracture gives rise to more danger from the shock, 
from the danger of tearing nerves and blood-vessels, fever, teta- 
nus, and the long process of suppuration incidental to such 
injuries. If principal nerves or arteries are torn or bruised, or 
other grave injuries present that would render repair impossi- 
ble, amputation may be required ; and divers other conditions 
present that render this class of injuries at all times serious. 

Treatment. — If it is decided to save the limb, then the rough 
or splintered broken ends must be sawn off, and the fracture 
set like a simple one, and an effort made by plugging the wound 
with a piece of sponge saturated with carbolic acid and olive 
oil, to hermetically seal the wound up, and make it a simple one. 
The object in view is to destroy all micro-organism ; coagulate 
the tissues. In eighty per cent, of all cases this will be suc- 
cessful if wound is thoroughly cleansed of clots, dirt, by wash- 
ing it out with an antiseptic wash. 

PARTICULAR FRACTURES. 

As this manual does not contemplate the people at large set- 
ting fractures, we shall briefly enumerate the principal special 
fractures, and simply hint at their best mode of treatment, so 
as to enable the members of the family to judge of the intelli- 
gence, ability, and ingenuity of the physician who has the case 
in charge. 

Fractures of the Skull. — Must all undergo trepanning, so 
as to enable the surgeon to raise and place in position the broken 
fragments. In children under fifteen, the cranial bones embrace 
but one plate ; the same condition exists in old age. Fractures 
among that class are apt to be serious, as the broken bones are 
pressed in upon the brain or its membranes ; whereas, in frac- 
tures occurring between fifteen and fifty-five, there is developed 



686 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

a cliploetic structure, which is spongy, intended to receive shocks, 
jars, and prevent them affecting the inner table. This diplo- 
etic structure gives us an outer and inner skull-bone, or table, 
and is beautifully arranged for the purpose. In fractures oc- 
curring in adult life, there is great probability of them only 
involving the outer table, which renders them much less dan- 
gerous. Trepanning is necessary to raise the bones. 

Fracture of Base of the Skull. — Is caused by falling from 
a height upon the feet. The vertebra? are incapable of ward- 
ing off the impetus of the shock, and its entire force is spent 
upon the base of the skull, which fractures, and is only known 
by the nature of the accident, and haemorrhage from the ear; 
no symptoms of fracture present. Inflammation of brain is 
likely to follow,which should be anticipated by proper treatment. 

Fracture of the Bones of Nose and Upper Jaw. — Generally 
produced by blows, or falls on face, or gunshot wounds. Any 
displacement should be rectified, any depressed fragments raised, 
loose splinters or projecting parts removed. The swelling, ecchy- 
mosis, bleeding from nose, congestion of head, to be attended to 
by keeping bowels open ; aconite. 

Fracture of the Lower Jaw. — Is usually caused by violent 
blows. Its common situation in adults is close to the eye-teeth ; 
in children, at symphysis, or at the angle of ascending ramus. 
The inability to move the jaw, the irregularity of the teeth, 
gums lacerated and bleeding, and crepitus can easily be detected. 

The paraffine dressing can be made to fit like a shield ; keep 
the bones in perfect apposition. If teeth on either side are loose, 
remove them ; liquid nourishment by a tube. The paraffine 
cap or mould to be held in position by a figure 8 roller round 
head. Union is very rapid ; two to three weeks. 

Fracture of Clavicle. — The collar-bone is often broken by 
falls upon the shoulder, and is easily recognized by the inability 
to raise the affected arm and support it at the elbow; the 
shoulder sinks downwards, forwards, and inwards. 

The treatment is simple ; raise the shoulder, and support in 
a direction backwards and outwards. This is best effected with 
what is called Fox's apparatus, which consists of a wedge- 
shaped pad for the affected side, a collar for the opposite shoul- 
der, and a sling for the elbow of the affected arm. 

It can be dressed in several other ways, but none so certain 
as with Fox's apparatus. 

Fracture of the Scapula. — Easily recognized ; best treated 
with a shield or cap made of paraffine, with arm in a sling. 

Fracture of the Humerus. — When it occurs inside of the 
joint, non-union or stiffness is likely to follow in spite of the 
best care. In some cases it is very difficult to make out, as 
there is often at first no symptoms present but pain ; and when 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 687 

later the broken fragments are coated over with lymph, no 
crepitus is heard. When it occurs outside of the joint, all the 
symptoms are present. All cases of fracture of or in the joint, 
and two-thirds of the length of the arm, should be treated by 
setting the fracture; then bandaging from the wrist up to the 
shoulder ; and by four splints, one in front, one back, and one 
on each side. Over all a bandage; arm in sling. 

Fractures occurring in the lower third of the arm, should be 
treated in all cases by an L splint behind, and one in front, 
to raise the broken part ; bandage before it is applied, and after. 

Fracture at Elbow-Joint. — The most common is the point 
of the elbow, or olecranon. It is often broken in children. It 
can readily be detected by the broken piece being drawn up- 
wards from three-quarters of an inch or more. 

This is best treated by running a strip of adhesive plaster 
half-way down the forearm to the broken piece, then leaving a 
loop, and running it half-way down the arm; it can be more 
firmly secured by strips of plaster across. Then take the loop, 
and twist it until the bone is brought down to its place; then 
bandage from wrist to shoulder ; then put on a straight splint 
on the front of the arm; over all another bandage. In two 
weeks the bandages and splint are to be taken off, loop slack- 
ened, bone held in place by the thumb of surgeon, and the 
joint moved half a dozen times; then the loop again twisted 
up ; dressing again applied in same manner. Passive motion 
every two or three days, so as to maintain the integrity of joint. 
Better to keep dressing on for ten or twelve weeks. 

Fracture of Fore-arm. — When occurring in the upper two- 
thirds of the arm, are best treated by two splints — one in front, 
other behind, a little wider than the arm; over these two splints 
a bandage, arm in sling. All fractures in the lower third 
should be treated by Bond's splint. Hand or fingers, when 
fractured, should be dressed on a ball of oakum, so as to main- 
tain the convexity of the hand and fingers. 

Fracture of the Ribs. — When the ribs are broken, they 
are either complete or incomplete. There is little difficulty in 
recognizing it when complete, by the grating sound on moving 
the rib ; when incomplete, there may be detected the depression, 
and the pleuritic catch or pain. 

In all cases let the patient lie down on his or her back in the 
easiest posture possible ; then, over the seat of fracture put on 
a large strengthening plaster ; over this run long two and a half 
inch strips of adhesive plaster in every direction, so as to con- 
fine the ribs ; then over all a fine flannel roller, reaching from 
the armpits to near the navel ; put pins in every three-fourths 
of an inch, beginning at the neck, and proceed downwards ; 
the object being to confine the ribs and breath by the dia- 



688 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

phragm ; patient to lay quietly on back for ten days, bowels 
moved, and treatment for pleurisy at once begun. 

Fracture of Pelvis — Is generally caused by tremendous 
violence, as getting crushed between car-bumpers ; viscera very 
liable to be injured, which causes such fracture to be very fatal. 

Encase the pelvis in a roller ; attending to bladder and bowels ; 
and anticipate peritonitis by administering opium and gelsemi- 
num. 

Fractures of Coccyx — Are usually caused by women over 
thirty-five having children for the first time. About that period 
of life ossification takes place, which breaks by the pressure of 
the head of the child. It may be caused by falls, kicks, etc. 
Cleanse out bowels with oil ; replace the broken parts ; apply 
compress and a T bandage, and lock up bowels with opium 
for ten days. If there is much coccydynia, belladonna sup- 
positories. 

Fractures of the Femur. — Fractures of the head of the 
thigh-bone inside of the capsular ligament of the joint occur 
most frequently in women over forty-five years of age, or in 
men a little older ; commonly the result of falls — treading on 
some fruit-skin. It often takes place without causing any other 
symptoms but pain and lameness of gait. In other cases symp- 
toms are well marked. 

When it occurs at the neck of the head of the bone, outside 
of the joint, there is no difficulty in recognizing it. All fractures 
of the thigh, except in the lower third of the bone, should be 
treated by keeping patient on back, on a hair or straw mat- 
tress ; then extension should be effected by placing adhesive 
strips on the limb up to the seat of fracture, binding them to 
the thigh, leaving no attachment on leg, carrying them beyond 
the sole of the feet, to which a weight of about fifteen pounds 
is attached, and the foot of the bed elevated one inch for every 
two pounds, so as to give the necessary counter-extension ; in 
other words the soles of both feet should be even. Lateral or 
side support, or pressure, should be effected by two long sand- 
bags the diameter of the patient's legs, one running from the 
armpits to four or five inches beyond the ankle ; the other on 
the inside of the thigh, reaching from the groin to four or five 
inches beyond the inner ankle. With a proper adjustment of 
this method all fractures of the thigh bone except the lower 
third can be successfully treated without any shortening. In 
the lower third the limb must be placed in a bent position as 
in fracture of the upper portion of the leg. 

Fracture of the Patella, or Knee Cap, is generally trans- 
verse. The upper fragment is drawn upwards by the rectus 
muscle, leaving a space between the broken bones. Place pa- 
tient on back ; run a strip of inch-wide adhesive plaster ten 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 689 

inches down the rectus to the cap, then leave a loop and run 
the same length down the leg ; twist the loop till the two broken 
pieces approximate perfectly ; then bandage limb from toe to 
groin ; put on a straight splint behind and bandage that to the 
limb. In two weeks dressing must be undone ; the broken 
bones held together by an assistant ; the joint moved so as to 
keep up a secretion of synovia. Dress as before. Use this 
form of passive motion every few days, so as to prevent a stiff 
joint. 

Fracture of the Leg, — The upper portion of the leg, when 
broken, must be kept in a bent position, at an angle of 45°, 
so as to relax the large muscle of the calf. The best dressing 
is a wire cage made to encase the front part of the thigh, leg, 
and foot. This can readily be made by a wire- worker. Bandage 
limb first after fracture is set, then apply this case, well padded, 
and over all a roller and suspend the limb from the ceiling. 

Fractures of the Leg and Foot. — Are all best treated by 
the fracture-box, with extension and counter-extension neces- 
sary to maintain perfect apposition. 

DISEASES OF JOINTS. 

The joints of the human body are simply so many hinges 
upon which the bones move, all finely lined with a soft, velvety 
membrane, which, during sleep, secretes a bland fluid for lubri- 
cation. This lining tissue is called a synovial membrane, and 
the amount of synovia secreted during repose depends greatly 
on the health of the individual ; if of good vital stamina, it is 
so great as to increase the stature by nearly an inch in the 
mornings. In cases where the nervo-vital fluid is deficient, as in 
masturbators, — the secretion is so deficient as to cause the joints 
to crack. If a joint is tied up, immovable for some time, and 
no demand made for this lubricating fluid, there is none se- 
creted. In all cases it is expended by healthy exercise during 
waking hours. 

(1.) Acute Inflammation of the Synovial Membrane, or 
Acute Synovitis, is produced by both local and constitutional 
causes ; the former are blows, strains, mechanical injuries, and 
especially penetrating wounds ; the latter are exposure to cold, 
rheumatic, gout, syphilitic, and mercurial poisons. 

Symptoms. — In the most acute form the symptoms are very 
severe, namely, high fever, delirium, violent aching pain in 
the joint, aggravated by the slightest motion ; great swelling, 
occurring soon after the pain ; redness and tenderness of skin. 

The swelling is peculiar, and distinctive of the disease. It 
is occasioned by the rapid effusion of fluid into the synovial 
cavity, and consequently if the joint is superficial, it fluctuates 
freely. It is always most prominent at the point where the 

56 



690 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

joint is least covered by ligament, and consequently it alters" 
the shape of the joint. When the knee is affected, it pushes 
the patella forward, and there is great swelling on each side of 
it, with general fullness of the surrounding parts. The limb can- 
not be moved without giving rise to the most excruciating pain. 

The synovial membrane when suffering inflammation be- 
comes extremely vascular, red, rough, tender ; granulations are 
very liable to form. 

Treatment, — Rest to the irritated, weakened joint ; it should 
be kept perfectly motionless; this is indispensable to success. 
Keep it in a paraffine splint ; dry heat, with hop, bran, chamo- 
mile flowers, or other light bodies during the day, and some 
stimulating ointment during the night. Bowels opened with 
salines ; aconite, veratrum, etc, for fever ; if due to mercury, 
iodide of potass ; if gout, phosphate of quinine ; if rheumatism, 
alkalies and colchicum. Pain in all cases to be relieved ; general 
alteratives and tonics. 

(2.) Chronic Inflammation of the Synovial Membrane 
of a Joint has the same causes and presents the same general 
features as the acute. There is no fever, but the pain is often 
severe, grinding, excruciating, with a sense of weakness and 
relaxation. The swelling is great, indolent, and the tissues 
around the joint are thickened, gristly, and the swelling loses 
its softness and fluctuation. It is very apt to give rise to pulpy 
degeneration of the membrane, with ulceration of the cartilage 
and destruction of joint. 

Treatment. — The points here are to reduce the inflamma- 
tion, correct the morbid state of the blood that gave rise to it, 
and get rid of the effusion and thickening and restore the parts 
to their proper use. The skin, kidneys, bowels, and appetite to 
be attended to; a general alterative and tonic course prescribed ; 
all pain removed from joint by stimulants. If swelling is great, 
it is a good plan — saves nature an immense amount of labor — to 
remove fluid from the joint by aspiration. There is no possible, 
danger in perforating the joint with a small trocar and draining 
all off, because a round orifice at once contracts. It should be 
closed with compressed sponge, and if there is thickening, apply 
the ozonized clay, at the same time pushing the alteratives. All 
sorts of blisters, irritating plasters, or irritants, should be avoided 
around joints. If there is pain, rest and hyoscyamus. 

(3.) Abscess in Joints. — The effused lymph in chronic 
inflammation, besides its tendency to soften and ulcerate the 
structures of a joint, has also a tendency itself to break down, 
and give rise to abscess. The pus should be evacuated by aspi- 
ration ; alteratives, and tonics; and stiffness or anchylosis 
guarded against. 

(4.) Chronic Gout and Rheumatism Affecting Joints, is 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 691 

very apt to give rise to peculiar alterations of all the tissues of 
a joint. In some cases they become irregular, enlarged, flat- 
ened, or covered over with excrescences, projections. In other 
cases the cartilage is worn away, leaving the bone bare, or in 
grooves, or covered over with projections. 

In this form of irritation there is usually racking pain in the 
affected joint, of a rheumatic, gnawing, wearing character, 
alwavs worse at the change of the weather, or the heat of the bed 
at night, It may not be aggravated by pressure. The joint 
becomes stiff, its movements limited, and accompanied by a 
grating sound ; muscles prone to waste, and limb becomes 
shorter. The general alterative and tonic course, as laid down 
under Gout and Rheumatism, with the local application of the 
ozonized clay, is usually efficacious in effecting a cure. 

(5.) Tubercular Disease in Joints. — Irritation of joints; 
the pain being of such an incessant, racking character, soon 
depreciates the reflex nerve centres, and causes that peculiar 
degradation of bioplasm, tubercle ; or the patient may have 
been tubercular before the irritation, in which case, in the weak- 
ened synovial membrane, cartilage, and ends of bone, tubercle 
is freely effused, which grows, and undergoes various processes 
of life, dies, and takes on its peculiar changes of degeneration. 
The wrist, hip, and knee-joints are the most obnoxious to tu- 
bercular deposits. It is not common over thirty years of age. 
The tubercular diathesis is always well marked. The greater 
prevalency of disease of the wrist, hip, and knee-joints is to be 
accounted for by the presence of pink marrow in the cancellous 
structure, which discharges the function of ordinary lymphatic 
glands. Above all other structures, the lymphatics are liable 
to tubercular deposit, when irritated and weakened. The pink 
marrow in the bones of the hand, the hip, and knee-joint, 
when weakened, becomes invaded with tubercle, in the same 
manner as the lymphatics of the connective tissue, but being 
in a solid, bony case, it has not much room for growth, which 
gives rise to much trouble. 

In the wrist, if suppuration has not taken place, the clay is 
the best local application ; if suppuration has occurred, matter 
to be removed by aspiration, and indurations softened by clay. 

In the knee, or white swelling, if the tubercle is in a fluid state, 
aspiration; if induration, the clay all the time, if no irritation 
is produced ; if suppuration has taken place, repeated aspira- 
tions, to remove pus. 

In the hip, or coxalgia, if seen early, counter-extension on the 
thigh, to keep the head of the bone from pressing on its cavity; 
rest, when not out in open air for benefit of health ; application 
of ozonized clay ; if suppuration has occurred, openings, poul- 
tices and clay, alternately. The use of the ozonized clay in the 



692 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

destruction of the tubercular germ in joints, has produced a 
remarkable revolution in treatment of this hitherto stubborn 
and intractable disease. Its success is immense. In all cases, 
there is to be inculcated an active tonic and alterative course, 
as laid down under the head Tuberculosis; a very nutritious 
diet ; attention to bathing, and all means conducive to improv- 
ing the general health. 

(6.) Anchylosis. — This term signifies a fusion or union of 
the ends of bones, and may take place, in a greater or less de- 
gree, in any joint that suffers from inflammation, it being due 
to effusion of lymph, the result of that process ; so that it be- 
hooves us, in the treatment of all joint affections, to keep the 
limbs in as favorable a condition as possible, in case this diffi- 
culty should arise. It is met with in two forms, false or spurious, 
and true or bony. The false is due to effused lymph, w T hich 
has become partly consolidated, thickened, organized into bands, 
adhesions, and become fibrous tissue, but still capable of being 
bent. The true, or bony, is when that same effusion becomes 
organized into bone, and is perfectly immovable. 

Treatment. — Before any attempt at cure, in either the false 
or true forms, be made, the patient should be examined as to 
whether he possesses any rheumatic taint ; if so, this should be 
corrected before treatment is commenced. 

For the false, gentle movements of the joints should be made 
once or twice daily, varying from a few minutes to half or even 
an hour ; if muscles are wasted, massage. At all other times 
the joint should be kept encased in ozonized clay, provided no 
redness takes place ; if that should take place, do not change 
clay often, simply moisten with hot water. 

In the true, or bony, the same precautions, as to Rheumatism ; 
then place patient under alcohol, chloroform, ether, and break 
the joint by forced rupture. Then let it rest a few days, and 
begin passive motion, as in the former — a little and a little, so 
as to produce no irritation. The ozonized clay to be kept con- 
stantly applied, which acts as a solvent to the effused lymph 
and bony deposits, and promotes their absorption. 

Internally, the best of diet ; alteratives, as glycerite of ozone, 
ozonized phytolacca, iodide of potass ; and tonics. The clay 
treatment entirely obviates the necessity of resorting to excision 
of the joint, as is generally resorted to. It takes very little 
longer ; makes a better cure ; and is devoid of all risks, and 
should be applied. When faithfully used, it operates like a 
charm. 

There exists an aversion among a very large number of phys- 
icians against interfering with stiff or anchylosed joints. This 
is now radically overcome, by the innocous character and great 
efficacy of the clay treatment. 



DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 693 

DISLOCATIONS. 

Joints are all encased in a strong capsular covering, or liga- 
ment, which retains or holds them in position, and forms a cap, 
cup, or reservoir to hold its synovia. This capsular covering, 
or ligament, is often weak, relaxed, and in some cases it is torn 
or lacerated, so that the head of the bone escapes from its cavity 
into the surrounding parts. If the covering of the joint is 
merely relaxed, the head of the bone may come out of its socket, 
but is easily thrown into its place by the individual himself ; 
but when it escapes through a tear, it requires relaxation of 
muscles, and manipulation to get it to recede back through the 
same opening by which it escaped. 

A dislocation, therefore, is the escape of the head of a bone 
from its natural cavity. 

Causes. — It may be caused by external violence, or muscu- 
lar action, and in some cases of diseased joints, by ulceration of 
the ligament. 

Symptoms. — The symptoms are two : deformity being the 
alteration in the form of the joint, in unnatural prominence 
at one part, a depression at another, with lengthening or short- 
ening of the limb. Loss of the proper motion of the joint. 
There may be numbness, pain, ecchymosis, swelling, etc., but 
no crepitus. 

Treatment. — If possible reduce the dislocation before the 
patient recovers frcm the shock, while relaxed ; if not, admin- 
ister lobelia, to nauseate him and relax, or else chloroform 
and ether. Better, as a rule, to relax the muscular system in 
all cases, either completely or partially. Then the head of the 
bone should be manipulated or manoeuvred back into the 
socket through the same opening through which it made its 
escape. The shoulder and hip joint are the only two that re- 
quire nice manipulation or rotation ; all others are brought 
into their place by simple extension, an assistant holding one 
part, and the other drawn gently into its place by the operator. 
After a dislocation has been reduced, the limbs should be band- 
aged up for ten or fifteen days, giving the tear in the capsular 
time to heal up. If it is complicated with fracture it is likely 
to give rise to a stiff joint, or anchylosis, under the best of care. 

Dislocation of the Lower Jaw. — May be caused by a blow 
on chin, or gaping wide. It is very easily recognized by the in- 
ability of the patient to close the mouth ; speech and degluti- 
tion almost impossible. Sit patient down on low chair ; place 
thumbs of both hands behind the molar teeth of lowar jaw, and 
press downwards ; at the same time elevate the chin, the head 
of bones will go into sockets, with a snap. Bandage jaw and 
head for a week. 



694 DISEASES OF MUSCLES, TENDONS, BONES, AND JOINTS. 

Dislocation of the Clavicle. — The end of the collar-bone 
next to the breast-bone is often dislocated forwards by blows on 
the shoulder. The bone on lying down returns to its place ; a 
firm compress over the part, and rest for a week. 

Dislocation of the Shoulder-Joint. — May occur in three 
principal directions : downwards, in the armpits ; upwards, on 
the collar-bone ; backwards, on the scapula. The first is easily 
known by a hollow w r here the head of bone should be, by 
numbness and lengthening of the arm ; in the two latter the 
arm is shortened, the head of the bone can be felt in its new posi- 
tion, on front or back. In the first form downwards in axilla, pa- 
tient laid on floor, relaxed, put sole of foot in armpit, and pull 
the arm, the head of the bone will return with a snap. In the 
other two, upwards and backwards ; the patient may sit on a 
stool, an assistant press the head of the bone back, while the 
operator rotates or manoeuvres the head back to its sock. Put 
arm in a sling for a week. 

Dislocation at Elbow. — May take place in six different 
forms, all easily known, and reduced by simple extension. 

Dislocation of Wrist and Fingers.— Treatment, simple 
extension. 

Dislocation of Hip- Joint. — May occur in four different 
directions : (1.) upwards, on the ilium ; (2.) backwards, in the 
sciatic notch ; (3.) downwards, into the thyroid foramen ; (4.) 
upwards, and forwards, on the pubes. They are each easily re- 
cognized by the lengthening or shortening of the limb ; by the 
inversion or eversion of the toes ; position of the foot and head 
of the bone. 

All reduced under relaxing ansesthetics by rotation, or by 
raising the head of the bone, producing extension, and other- 
wise. 

Dislocation of the Knee and Foot. — All by simple exten- 
sion. 

All bones should be replaced as soon as possible, as there is a 
tendency on the part of nature to fill up joints or cavities with 
lymph when not used, and to form a new socket for head of 
bone in new position. It is impossible to say how long nature 
takes in case of hip-joint. I have effected reduction when out 
eighteen months ; other joints often blocked up in a few weeks. 

In the treatment of all dislocations we would imperitively 
insist upon rest to the lacerated synovial membrane after reduc- 
tion of the luxation, for a period of two weeks; the object in 
view being, to aid nature in healing or closing the aperture 
through which the bone had escaped. If vital force is normal 
this is effected in one week, but longer time is required if there 
is the slightest deviation from health. Hence the precaution 
of a longer period of rest. 



CHILDBIRTH. 695 



CHILDBIRTH. 



PREGNANCY. 

Conception consists in the fertilization of the ovum or egg of 
the female, by the spermatozoa of the male in the ovaria; then 
fecundation takes place. There must be a union of the two 
materials furnished by both sexes ; that is, the spermatozoa 
must unite with the egg in the ovary and fertilize it; and the 
embryo results from this union. The spermatozoa is ejacu- 
lated into the vagina ; the uterus, by inhibitory action and ver- 
micular movements, takes it into its cavity, and passes it along 
the fallopian tubes to the ovaries. It may occur without the 
patient being conscious of its occurrence, or against her will. 
The most favorable period for conception to take place is either 
before or after a menstruation. After the ovum is impregnated, it 
increases in size and becomes prominent on the ovarium ; then 
absorption of its peritoneal coat takes place ; and when free, is 
seized by the fimbriated extremities of the fallopian tube, and 
carried into the cavity of the uterus. 

The ovum, as a general rule, is found in the uterus twenty 
days after impregnation, sooner or later. 

After the exfoliation of the ovum from the ovary, an effusion 
of blood takes place into the cavity in which the egg was em- 
bedded, and this is followed by a corpus luteum. 

The human impregnated egg is very small, about the size of 
a dwarf pea. When impregnation takes place, the internal os 
uteri becomes closed by a soft, gelatinous substance, and the 
internal lining membrane of the uterus throws out a flocculent 
or downy substance, which fills its cavity entirely. This is 
called the membrana decidua, and into this downy bed the 
ovum drops when it makes its exit from the fallopian tube, and, 
if not disturbed, will form its attachment near the point of 
ingress, and cause a growth of that part with which it comes 
in contact, and is called the decidua reflexa. So that the decidua 
is now divided into that portion lining and in contact with the 
uterus, called the decidua vera, and the other portion called the 
decidua reflexa. • 

The embryo then becomes covered with two membranes — 
the chorion and amnion. The amnion is an internal lining 



696 CHILDBIRTH. 

serous membrane, which furnishes a fluid for the protection of 
the embryo — allows space, facilitates motion and development 
of the foetus, and wards off shocks, jars, concussions. The 
chorion, or outside covering, furnishes a means of communica- 
tion with the uterus. 

The ovum, after its establishment within the uterus, consists 
of the decidua, decidua reflexa, chorion, amnion, liquor annii, 
foetus, and umbilical cord, with one extremity attached to the 
child, the other to the membranes at the point of attachment 
in the after-birth. The after-birth, or placenta, is a plexus of 
vessels by which the circulation is maintained between mother 
and child, and by which the latter is nourished. When of full 
size, it is from six to eight inches in diameter, and its thickness 
varies from a line to one inch, or more, at its centre. It has 
two surfaces : one attached to the uterus, which is rough, spongy, 
traversed by ditches ; and the foetal side, which is lined by the 
amnion, which is smooth. 

For the first three months of intrauterine existence, this twig 
of humanity is termed an ambryo ; the latter six, a foetus. As 
soon as impregnation takes place, the walls of the uterus become 
greatly infiltrated with blood, which increases the size of the 
vessels from being very small and convoluted, to that of large 
and straight ; the muscular fibres grow with perfect regularity. 
This increase of growth and development for the first three 
months is very great, so much so that the specific gravity of 
the uterus is so much that its broad ligaments are unable to 
hold it up, and it descends very low into the cavity of the pelvis, 
often nearly protruding. After the fourth or fifth month this 
difficulty is entirely obviated, by the uterus floating above the 
pubes; and at six months it is still higher. After the fifth 
month there is a gradual distension of the body of the uterus, 
which encroaches upon the neck, distending it, merging it into 
the body, and causing it to become shorter and shorter, until, 
from the eighth to the ninth month, it is entirely obliterated ; 
that is, merged into the body. 

Signs and Symptoms of Pregnancy are divided into 
rational and sensible signs. The rational signs embrace — 
First and Second Months : 

A stoppage of the menses, nausea, vomiting, flatness of the 
abdomen, depression of the umbilical ring, tumefaction and 
tenderness of the breasts. 

Third and Fourth Months : 

In addition to the above, there is now a slight fullness of 
the abdomen, augmented swelling of the breasts, prominence 
of the nipple, and discoloration around areolae. 
Fifth and Sixth Months : 
The disturbance of the digestive organs usually disappears; 



CHILDBIRTH. 697 

abdomen becomes well rounded and full, and the uterus can 
be detected above the pubes ; fluctuation can be detected ; and 
the color around the nipples becomes brown. 
Seventh and Eighth Months: 

Abdominal tumor large ; discoloration of the skin of the 
abdomen common ; often varicose veins of the leg, labia, vulva ; 
vaginal granulations; leucorrhcea, pruritis, and real copper- 
color around nipple ; and suppression of the menses through the 
entire nine months. 

First Half of the Ninth Month: 

Vomitings liable to reappear ; the abdominal swelling is so 
great that the skin of the abdomen is stretched, tense ; there is 
difficulty of breathing ; oedema of feet. 

Last Half of Ninth Month : 

Vomiting ceases ; abdomen relaxes; uterus descends; there 
is less difficulty in breathing, but more in walking ; often diffi- 
culty of urinating — sometimes suppression, in other cases an 
inability to hold it ; often piles ; varicose veins of the leg ; pains 
in the loins ; cramps in the legs ; colic, etc. 

The sensible signs embrace — 

First and Second Months : 

Augmentation in the size and weight of the uterus causes that 
organ to descend low down in the pelvis ; it cannot be moved 
easily ; its walls touch the neck, which is directed downwards ; 
the orifice or mouth is rounded, swollen, and a slight softening 
of the lips. 

Third and Fourth Months: 

The fundus of the uterus rises above the pubes, and a rounded 
swelling can be detected by palpation. Making the patient 
stand up, and putting the finger on the os uteri, and lifting it 
up, it drops suddenly down on the finger. 
Fifth and Sixth Months : 

The fundus can now be detected below the umbilicus ; there 
are active movements of the foetus ; foetal heart can be detected 
distinctly, indeed, it is very perceptible. The uterus can be 
mapped out, fluctuating, rounded ; and the lower half of the 
neck of the uterus is softened, and the neck now begins to lose 
itself in the distension of the body. 

Seventh and Eighth Months: 

The increased size of the uterus and abdomen ; the fundus 
of the uterus is three finger-breadths above the umbilicus at 
the seventh month, four or five at the eighth ; movements of 
foetus stronger ; foetal heart very clear ; neck disappearing in 
the body. 

First Two Weeks of Ninth Month : 

The fundus of the uterus reaches the borders of the false ribs, 
clear up to the stomach; foetal heart very strong; neck of the 



698 CHILDBIRTH. 

uterus gone entirely into the body ; the mouth of the uterus 
open. 

Last Fortnight : 

Fundus sunk low down ; movements active ; mouth of uterus 
open, soft, dilatable ; the whole cavity of the neck becomes con- 
founded with that of the body. 

The entire period of pregnancy occupies nine calendar 
months, or forty weeks. Time varies somewhat, as to whether 
conception took place immediately before or after menstruation. 

Pregnancy may be protracted in some rare cases ; that is, 
carried out beyond two hundred and seventy-eight days, the 
interval between the last day of the menstruation and the ex- 
pected confinement, and at least a fortnight more than this. 
There is no very exact time,- or number of days, to which preg- 
nancy may be protracted ; still, it would be safe to maintain 
that in no case can it be prolonged over three weeks beyond 
the natural period. 

Development of the Foetus. — Fifteen days after the ovum 
or egg appears in the uterus, it is a gelatinous, semi-transparent, 
flocculent, greyish mass ; at thirty days, the size of a large ant, 
and from three to five lines in length ; at six weeks, ten lines in 
length, about the size of a bee, but some of the organs, in a 
very rudimentary state, visible ; at two months, two inches long, 
weighs two ounces, and ossification has commenced at some 
points ; at three months, three and-a-half inches long, weighs 
three ounces ; umbilical cord well formed, and genital organs 
distinct ; at four months, five to six inches long, weighs from 
four to five ounces ; at four-and-a-half months, quickening, or 
motion is felt by the mother, or by placing the cold hand on 
the abdomen, and it is now from seven to nine inches in length, 
and weighs from nine to ten ounces ; at six months, parts pretty 
fully developed, and weigh from one to two pounds, and its 
length from nine to twelve inches ; at seven months, all parts 
are perfectly developed; weighs from two to three pounds, and 
in length from twelve to fourteen inches, or more, and per- 
fectly developed ; at nine months, usually twenty inches long 
and average weight seven pounds ; bones of head firm ; ossifi- 
cation more complete, and all the organs capable of perform- 
ing their natural function. 

Some variation in the above, but it gives the general average. 

There may be several eggs fertilized, so that there may be 
twins, triplets, or quartlets. Pregnancy may occur outside of 
the uterus, extrauterine, it may take place in the ovary, and 
the embryo develop there ; or it may be developed in the fallo- 
pian tube, or in the abdomen, or the ovum may find its way 
into the muscular coat of the uterus and be developed. The 
consequences of such are usually serious, causing inflamma- 



CHILDBIRTH. 699 

tion, ulceration, suppuration, internal hemorrhage, and death 
to the mother. 

When pregnancy takes place, and the woman knows she is 
in that state, she should eat the best of food, take moderate 
exercise, but avoid hard work or any strain, and above all, 
keep her bowels regular by eating sufficient fruit, or else ene- 
mata of milk and water. She should make a regular habit of 
either sponging or bathing the entire body once a day. All 
gloomy or idle fears should be banished ; no tales of woe or 
sorrow told in her presence ; her surroundings should be of the 
most agreeable kind, and she should place her trust in the 
benevolence, mercy, and wisdom of her Creator. Her clothing 
should be flannel, next the skin, at all seasons ; she should 
have abundance of sleep, and all symptoms in this state should 
be managed with as few drugs as possible. The sickness of 
the stomach is one of the earliest of all symptoms, and should 
be treated with the plainest bitter tonics. 

Vomiting of Pregnancy. — The morning sickness, with or 
without vomiting, is one of the earliest and most persistent of 
all the symptoms of pregnancy. It is due to a great variety of 
causes : it maybe purely reflex, an irritation transmitted from 
the uterus to the co-ordinating chemical centre at the base of the 
brain ; this is the most common kind — a morbid enervation, 
a reflex sensation. This is frequently bad, and sometimes fatal 
it usually ceases after four-and-a-half months, but may con- 
tinue all the time. It is arrested when the foetus dies, or by 
abortion, miscarriage, or delivery, at full time. It is not ac- 
companied by any grave disorder, except deficient secretion. 

Other cases depend in a great measure upon a catarrhal 
condition of the salivary glands of the mouth, salivation, ca- 
tarrh of the stomach and duodenum, and slight jaundice, and 
those cases are very liable to abort. But there are other kinds 
of vomiting which prove fatal suddenly and unexpectedly, 
without any apparent cause. Vomiting is sometimes due to a 
degeneration of the glands, such as the liver and kidneys, 
which is common in healthy pregnancy and nursing. Like the 
watery blood of a pregnant woman, it is not called a disease, 
but a normal condition. This degeneration, however, is dan- 
gerous to women in a variety of ways. In nearly all fatal 
cases of vomiting, during or immediately after pregnancy, 
there is less or more jaundice or uraemia ; in these the liver and 
kidneys have suffered, and the fatal result is preceded by leth- 
argy, coma, if not a discolored skin. Here death results from 
a granular degeneration. Even slight vomiting and jaundice 
with or without albumen in the urine, are dangerous and often 
fatal in the puerperal state. Decided yellow atrophy of the 
liver is only present once in a thousand cases of pregnancy, 



700 



CHILDBIRTH. 



whereas uraemia is common one in five hundred cases. Still 
there are a minor class of cases that must be looked upon 
with suspicion. These conditions are not to be laid to pressure 
of the gravid uterus upon either the liver or the kidneys, for 
such does not exist, if at all, until the later months. No defi- 
nite line of treatment can be laid down for any one case. Rem- 
edies must be tried, and if found successful persevered with. 

The recumbent posture should be maintained till one hour 
or more after the morning, or other meal. Bowels must be 
kept regular. 

A cup of strong coffee, or caffeine, or guarana, could easily 
be tried ; often acts promptly. 

Carbonic acid gas acts as a stimulant to the base of the brain, 
and could be tried in the form of champaign, apollinaris or 
clysmic water, soda water, or tartaric acid and soda. 

Pui e stomach sedatives are to be found in the oxalate of cerium 
in five-grain doses thrice daily ; or in the secondary action of 
ipecac in one-eighth, not more than one -fourth -grain doses 
thrice daily. 

Pepsin and ingluvin before meals are often of great utility 
in arresting the vomiting, and deserve a fair trial. Whichever 
is selected should be given fn large doses ; they often act like 
a charm. There can be little doubt that before meals is the 
best, and in large doses, so that the stomach will make as little 
demand on the anaemic nerve-centre for secretion as possible. 

Hot applications over the stomach may be tried. Milk and 
lime-water in small quantities. Bitter tonics, as chamomile 
flowers, columbo, made into a tea and drunk before meals, are 
sometimes of service. 

Depraved Appetite. — An abnormal form of appetite, in 
which there is a craving, or longing, or intense desire, for very 
remarkable substances, as sand, cinders, slate-pencils, chalk, clay, 
coal, sponge, candies, and other articles. 

The primary cause is no doubt one of nervous prostration or 
exhaustion in the co-ordinating chemical centre in the brain, 
bulb, and cord, brought into activity by pregnancy, uterine 
irritation, chlorosis, masturbation, worms, or some reflex irri- 
tation transmitted to those weakened or anaemic parts. 

There is usually associated with it pallor, anaemia, mental 
depression, emaciation, colicky pains, diarrhoea, acidity, and 
symptoms of nerve-tire or debility. 

The best remedies are port wine and Peruvian bark; bitter 
tonics, as golden seal ; moderate exercise and healthy amuse- 
ments, bathing, friction, and other means to improve the health. 

If not pregnant, more active measures should be resorted to, 
as seclusion, rest, massage, electricity, general alterative and 
tonic course for a few months. 



CHILDBIRTH. 701 

General Symptoms of Pregnancy. — The large proportion 
of the symptoms of pregnancy are reflex ; that is, they are 
dependent in a great measure upon some loss of tone, or weak- 
ness of the co-ordinating chemical centre at the base of the 
brain ; or impaired vitality of the medulla oblongata, or de- 
bility of the spinal cord ; and when pregnancy, or any condi- 
tion "of molecular activity of the uterus takes place, the excite- 
ment is transmitted to the bulb and cord directly from the 
uterus to those centres, and thence to the weakened nerves ; 
hence we have toothache, salivation, if the nerves of the mouth 
are weak ; nausea, vomiting, headache, heartburn, water-brash, con- 
stipation, or diarrhoea, if the nerves of the stomach have suffered 
a partial loss of vitality ; or there may be faintings, loss of 
voice, difficulty of breathing, sleeplessness, hypochondriasis, 
convulsions, difficulties of sight and hearing ; chorea, epilepsy, 
and neuralgic pains in the breast or elsewhere. 

Now, with reference to all these and numerous other symp- 
toms, we say palliate them the best you can, and, above all 
things, avoid medication in pregnancy if possible. Most physi- 
cians treat those cases shamefully by pretending to give drugs, 
while they are simply sugar pills, or sugar of milk, so as to 
operate on the credulity of the patient and her friends. This 
is very wrong ; it is taking money under false pretence. 

No nitrous oxide gas should be administered for the painless 
extraction of teeth, because the nitrate of ammonia, of which 
it is composed, increases the alkaline constituents of the blood, 
and is very liable to cause abortion. The pain of toothache can 
be relieved by the local application of morphia, or aconite, bella- 
donna, and chloroform. 

Symptoms of indigestion can be relieved with pepsin or bitter 
tonics, diarrhoea arrested with the opium and tannin pill, and 
constipation relieved by fruit. In cases of loss of voice, it can 
usually be relieved by inhaling the vapor of warm water, with 
a little ammonia ; fainting or difficulty of breathing can usually 
be ameliorated by some diffusible stimulant ; sleeplessness or 
hypochondriasis, by extract of hops or coca ; and neuralgic 
pains in the breast, by heat. 

With Regard to Convulsions, Epileptic Fits, Chorea, the 
best plan in all cases is to suspend them, and let pregnancy 
take its chances. When we estimate the devastation that these 
would, if permitted to continue, produce in the nervous system 
of the mother, there can be little doubt about the use of our 
most powerful remedies to prevent them ; and those very drugs 
are abortive in their action, because it is really impossible to 
treat those fits with success without bromine, iodine, potassa, 
snakeroot. 

Irritable Bladder* — In the large per cent, of cases, where a 



702 CHILDBIRTH. 

pregnant female wants to make her water every few minutes, 
it is due to the presence of uric acid in the urine, which can be 
remedied by a change of diet and benzoic acid, without the use 
of other drugs, that might be likely to injure the foetus or cause 
the patient to miscarry. Still, the irritation may be due to 
something adjacent, as caruncle of the urethra ; lupoid, or other 
ulcers around the hymen ; sympathy from an inflamed uterus, 
rectum, or other adjacent parts ; and other forms of irritation. 
If the case is bad, it must be remedied at all hazards, the 
mother's life being paramount in all cases. Mild but efficient 
means must be resorted to, as alkalies, as sweet spirits of nitre, 
to keep urine alkaline ; suppositories of belladonna and opium, 
and general treatment as laid down under that head. 

Menstruation During Pregnancy and Lactation. — The 
appearance of the menses during pregnancy or lactation, or 
both, is to be looked upon as a grave condition, which weakens 
the mother and impairs the vitality of the child, causing it to 
be very tubercular. 

The causes that have rendered this so very common these 
last twenty years are somewhat obscure. Some attribute it to 
the excitement incidental to a state of high civilization, with 
its worry and care ; others assert that it is the influence of the 
modern class of literature, which has wrecked the frame-work 
of the female organism ; others, to the sewing-machine and like 
occupations ; while another class claim it to be caused by sex- 
ual excesses and stimulating diet. Certainly it is some defect 
of modern civilization, for thirty years ago the condition was 
unknown. Occurring during pregnancy, it is to be carefully 
distinguished from those cases where the after-birth is over the 
mouth of the uterus, when, after the fifth or sixth month, there 
is a bloody dribbling from the uterus daily. 

The appearance of the menses during pregnancy and nursing 
is to be regarded as a weakness or want of vitality of the uterus 
and ovaries, and every possible means taken to arrest it by 
proper treatment. The patient must avoid all excitement; 
take a good deal of rest ; not to use sewing-machine, nor go to 
shows, theatres, balls ; not to read light or fictitious literature,, 
but solid history ; and avoid the other causes. She should eat 
well ; have perfect freedom from worry, care, or work ; take the 
struggle for life easy ; and as remedies, the cold water hip-bath ; 
port wine and Peruvian bark, the viburnum compound, the 
mother's cordial, the stylosanthes — one of those remedies taken 
three times a day. The stylosanthes has a most remarkable 
quieting action on the uterus ; although not much used, it is 
here invaluable. Use remedies persistently until it is arrested. 

Albuminuria, or Dropsy, in Pregnancy. — Bright's disease 
of the kidneys often makes its appearance in pregnancy. The 



CHILDBIRTH. 703 

question at once strikes one : What has the kidneys to do with 
the uterus? The urinary and genital organs are closely con- 
nected, so much so that they sympathize strongly with each 
other. True, the dropsy and albuminuria are most common 
after the four-and-a-half months, when the uterus floats- up, 
and to some extent presses on the kidney. Those cases are to 
be looked upon as very grave ; they usually involve the death 
of the foetus, by causing a disease of the after-birth from the 
watery condition of the blood present, and latterly the death 
of the mother. The usual course of treatment cannot be adopted, 
as it will cause abortion and fatal results. In some rare cases, 
benzoic acid causes a rapid disappearance of both albuminuria 
and dropsy. It is given in ten-grain doses thrice daily. As- 
tringent tonics, as port wine and cinchona, or port wine and 
gallic acid, may be tried. 

Pruritis of the Vulva. — The distress that pregnant women 
sometimes experience from itching about the entrance of the 
vagina is often terrible. 

The cause is one or other of two things : either the sugary 
pabulum of diabetic urine, or the alteration in the nutrition of 
the parts from neurosal impairment, or the two combined. 

In all cases there is a fungus organism present, and requires 
the use of a parasiticide. 

Borax is the best and safest remedy. It is well not to use it 
with glycerine, as the glycerine has such a strong affinity for 
water, and often aggravates. A strong decoction of poppies or 
elder flower water can be used with advantage, and they form 
excellent vehicles for the borax. The boracic acid is also ex- 
cellent, but not so soluble in water as the plain borax. No 
internal treatment of any use. The difficulty disappears as 
soon as confinement is over, the sugar disappearing from the 
urine. 

Eruptions and Excoriations about the Pudendi are usu- 
ally of the character of eczema, and it is also due to the sac- 
charine urine dribbling down, and acting as a local irritant; 
and when the eruption is once caused, this renders it intoler- 
able and intractable, and excessively irritating in this region, 
and often incurable as long as the pregnancy exists. The 
changing of the diet, forbidding sugar, and using light animal 
food, with eggs, milk, fish, etc., does not do much good. Vase- 
line or ozone ointment can be smeared over the part three or 
four times a day. It will palliate the irritability at least, which 
is about all that can be done. The difficulty disappears promptly 
as soon as labor is completed. 

Any cracks or abrasions should be treated by an infusion of 
poppies, followed with ozone ointment, which should be used 
freely. 



704 CHILDBIRTH. 

Piles are usually the result of liver trouble, and must never 
be treated by sulphur, nux, mandrake, or other liver stimu- 
lants, because those drugs are active abortive remedies. Keep- 
ing the bowels regular with fruit, diet, or senna and prunes, 
and local cold water baths, is all that should be attempted. 

A watery, or other discharge from the vagina, may be relieved 
with port wine and cinchona. 

Swelling of the labia is to be relieved with rest. 

Varicose veins of the limbs to be relieved by a bandage or elastic 
stocking during the day, and the limb bathed morning and 
night, well dried, and then rubbed with extract of hamamelis. 

Cramps in the limbs are to be relieved by rubbing. 

Inability to hold the urine, or retention of urine, is usually 
due to pressure and debility. Rest, and the use of the mother's 
cordial, or the viburnum compound, relieves this difficulty. 

Although we thus deprecate drugging during pregnancy, 
and recommend palliation and rest, yet it is not good to the 
health of a pregnant mother that she house-up too much. She 
needs gentle, moderate exercise and change, as conducive to a 
high state of mental and physical vigor. She should not ex- 
haust her body by work, nor her brain by worry or study. 
She should cultivate the higher and holier attributes of her 
nature; avoid as much as possible sameness or monotony. 
Avoid literary pursuits above all things, as it wearies the mind 
and arrests brain development in her offspring. 

Undue tightness of the abdomen is best relieved by rubbing it 
with warm olive oil once or twice daily. 

Spurious Pregnancy. — This is a peculiar condition, which 
sometimes gives rise to all the symptoms of true pregnancy, 
even the morning sickness, the suppression of the menses and 
the progressive enlargement of the uterus having a perfect 
resemblance to a genuine gravid uterus. It will even commu- 
nicate the sensation of movement, or tenderness on pressure, 
and dullness on percussion ; the breasts may increase in size, 
and even secrete milk, and the progressive enlargement of the 
abdomen may continue for nine months, and the phenomena 
of labor supervene. The pains may even come on and suc- 
ceed each other, becoming stronger and stronger, and latterly 
ceasing by a return of the abdomen to its natural state, and 
perhaps a slight fever. On an inspection of the tumor, it is most 
generally in the centre of the abdomen. The navel is never 
protruded ; there is no striae over the abdomen. On feeling it 
with the points of the fingers, the tumor is elastic, and its 
boundaries can be traced easily. It has no connection with 
the liver, spleen, ovaries, or uterus ; no sign of foetal heart or 
rumbling noises. 

The cause of this phantom tumor is some exhaustion of the 



CHILDBIRTH. 705 

cord, bulb, and base of brain — a true condition of anaemia, ex- 
haustion, and irritation, which is transmitted to the diaphragm 
and other abdominal muscles, which causes contraction, and 
gives rise to an appearance exactly resembling a body, or gravid 
uterus, or tumor. If there is any doubt about it, place 'the 
patient under chloroform, when the contraction will entirely 
disappear. In such cases, when carefully examined, it will be 
found that the general health is feeble ; there is great exhaust- 
ion of the nerve-centres, or strong hysteria. We use the term 
because we have no other by which we can describe the morbid 
condition of the cord that is present. There is likely to be 
associated with it irregular uterine functions, dyspepsia, ovarian 
irritation, or some form of chronic disease. Same treatment as 
for Hysteria. 

Deformities and Mutilations, — It may be laid down as a 
general rule that all deformities, such as hair-lip, club-foot, 
imperfect arms, etc., are due to incompatibility of temperament 
or close consanguinity ; whereas mutilations, monstrosities, are 
due to shocks, frights, impressions, sights made upon the mother 
during the embryonic period, the first three or four months of 
intrauterine life. Probably amputations of the arms or limbs 
may occur later. The prevention of deformities is in the hands 
of the parties entering the matrimonial field, and should be 
regulated by stringent laws ; whereas the prevention of muti- 
lations is in the hands of the mother alone ; she should avoid 
reading all dime-novels, fictitious literature, going to theatres, 
witnessing the killing of fowls or animals, or of seeing, hearing, 
or feeling, any strange or abnormal thing that would be likely 
to vividly impress her. 

LABOR. 

Six weeks or two months before the termination of pregnancy, 
it is expedient for the coming mother to take a dose of castor 
oil once or twice a week, not so much for a free unloading of 
the bowels as to get up a good secretion of milk ; for there is 
no drug like the oil for this purpose. It is also a good plan to 
let the patient take some remedy to strengthen up the womb 
for its approaching work. There are three good preparations 
for this purpose, namely : the mother's cordial, the viburnum 
compound, and the fluid extract of stylosanthes ; either of 
these, the one alternately with the other. The latter-mentioned 
remedy is a most marvellous one in rendering labor easy ; re- 
lieves the distress ; gets away with false pains ; is a valuable 
parturient, rendering the first stage of labor short and almost 
painless. It is an invaluable drug to all child-bearing women. 
As we have already stated, it should be commenced six or eight 
weeks before the expected crisis. 

57 



706 CHILDBIRTH. 

Labor may be defined to be the expulsive efforts of the uterus 
and mother in evacuating the contents of the uterus, the foetus 
being a mere passive body. Mental excitement or impressions 
may excite or suspend labor, but cannot prevent it. 

Symptoms of labor may be briefly enumerated : When the 
fortieth week has expired, there is likely to be some nervous 
depression, which is manifested by a rigor or chill of more or 
less intensity ; a frequent inclination to make water, or else a 
suppression of it, bearing-down ; subsidence of the abdominal 
tumor ; secretion of mucus, often streaked with blood, called 
the show; aching in the hips or thighs; sometimes cramps, 
and a dilatable condition of the mouth of the womb, with 
alternate contractions, accompanied with pain. In some cases 
the pains are false or spurious. They are said to be such when 
the mouth of the uterus remains unaffected by them. These 
pains in some ladies are apt to come on several days before the 
genuine, and are apt to worry or annoy the patient ; and in all 
cases in which you are satisfied that they are false, they should 
be stopped by an injection of starch and laudanum into the 
rectum. 

True pains are produced by contraction and drawing up of 
the womb, which first expels the slimy matter, mixed with 
blood, called a "show." As soon as this appears, the mouth of 
the womb at each pain begins to open and widen itself, so as to 
permit the contents of the womb to pass. 

When labor begins, the mouth of the womb is opened by 
the longitudinal fibres which are opposed to the circular. 

Labor is very correctly divided into three stages : the first is 
the period of dilating of the mouth of womb sufficient to let the 
head of the child pass, and occupies more than two-thirds of 
the time of a labor ; the second is the expulsion of the child from 
the uterus, and occupies much less than a third ; and the third 
stage is a complete expulsion of the membranes and placenta. 

The first pains are short, come on at long intervals ; the pa- 
tient is restless under them, first hot, then cold, and not infre- 
quently sick at the stomach. She may be griped, belches wind, 
or passes it from the bowels, which should not be restrained by 
false delicacy. By and by pain passes to the back and then to 
the bottom of the belly, and there is usually a desire to uri- 
nate or to go to stools, calls that are to be obeyed, never 
neglected. Just at this time she is likely to become fretful, 
uneasy, and may ask for something to hurry up pains ; but be 
patient, wait a little, don't force nature to premature efforts ; let 
her rest while nature rallies, and the womb gradually opens. 

The duties of the nurse, midwife, or physician, if the presen- 
tation is all right, consists in aiding, if needed, giving consola- 



CHILDBIRTH. 707 

tion and encouragement; warm drinks; watching the case 
carefully and closely, and rendering assistance when necessary. 

During the First Stage : At this stage,- itis unnecessary for the 
patient to go to bed, only once in a while, for examination. 
She is better during the greater part of the first stage, moving 
gently about the bed-room, and when a pain comes on, be in a 
position to get hold of something. During such pains a doubled 
up position, either sitting on a low stool, or kneeling, answers 
well. When this first stage is nearly over — that is, dilating 
the neck of the womb completed, the patient must go to bed. 
The best position for American women is the left side, near the 
foot of the bed, so that she can fix her feet firmly against the 
bed-post; her hips from ten to twenty-four inches from the 
edge of the bed. If attendants are few she could have a sheet at- 
tached to the bed-post, so she could hold on to something from 
below; her legs bent, a pillow between her knees, and her 
head also supported by a pillow. The bed for about a yard 
and-a-half square should be protected with a gum, or oil-cloth 
spread, and two or three quilts doubled up over the same, so 
as to take up the discharge. Irish or German women, with 
straight sacrums, do fully as well on their backs, or even on 
their knees, in the bed, or on the the floor, until they are well 
over and into the second stage. Once it is ascertained that 
the presentation is a good one, it is unnecessary to annoy her 
by repeated examinations. 

All examinations should be made during a pain, and con- 
tinued when the pain is off. If the pains are good, efficient, 
and the mouth of the womb well dilated, parts well lubricated 
and the membranes seem to act as a retarding element, they 
can be ruptured by roughening the nail of the index finger ; 
but if they do not seem to retard the labor, they may be let 
alone, until the}' almost protrude externally, as they act as a 
good dilator. 

The bag of waters differs in size in different cases, according 
to the amount of water present, and is, always, large or small, 
a good dilating body, continuing to force open and widen the 
mouth of the womb, until it is open sufficiently to permit the 
head of the child to pass. It also distends or dilates the vagina. 

In some cases, ladies, by excessive or violent movements, 
cause a rupture of the membranes, a week or more before labor; 
then labor is dry, and is not nearly so easy ; in other cases of 
sudden or hurried labor, the membranes, water, child, and 
after-birth are expelled in a mass, then the child is said to be 
born with a caul. When they burst at the proper time the 
pains continue, and the child gradually enters the world. If 
the mouth of womb is dry and rigid, so that the pains are in- 
efficient and the first stage prolonged, this rigidity must be 



708 CHILDBIRTH. 

overcome in various ways, — enemata of tepid water and lobelia 
into the rectum, steaming the vulva, perinaeum, and anus, by 
causing the patient to sit on a chamber partially filled with 
boiling water in which a plug of tobacco has been cut up ; or by 
smearing the rigid mouth with belladonna ointment, or intro- 
ducing a pastile of belladonna and opium into the vagina ; and 
if it does not yield, these means may be repeated, or they can 
all be used. A decided nausea has an excellent effect. 

When the head is emerging under the arch of the pubes, the 
perinseum should be supported with the palm of the left hand, 
and retained there till the head is free from the vulva. 

If the perinseum is tough, rigid, not easily distended, and 
thus obstructs the exit of the head, it may be well oiled, and 
hot towels — as hot as can be borne — applied, one after the other, 
so as to relax it. If this is unavailing, wring the towels out of 
hot lobelia or tobacco-water. 

When the head has made its exit, do not pull or drag it, but 
simply hold it in the hand until the next pain, and, when it 
occurs, have the patient hold her breath well and bear down, 
when the body will be expelled. Indeed, all through the case 
the patient must exercise great fortitude, patience, and for- 
bearance; be quiet and docile, and on no account must she 
throw up her arms, stretch herself, or let go her breath in the 
middle of a good bearing-down pain or effort. Some ladies are 
remarkably sensitive, and the greatest delicacy and kindness 
should be observed towards her in all things. Her person must 
not be exposed. There is little use in the horrid custom of some 
physicians, inserting their hand up the vagina in the form of a 
cone, and holding it there. Such a practice is uncalled for ; 
more good can be obtained by gently rubbing her abdomen 
with oil. The fantastic manoeuvres of self-conceited, ignorant 
physicians in wearing towels on their arms, sleeves ; putting 
on aprons, as if it was a butcher shop, and such like, are revolt- 
ing to the sensibilities of a refined lady. Such scoundrels should 
be kicked out. 

Cool, firm determination, a cheerful disposition, with the use 
of warm stimulating drinks, are of more utility than a lot of 
humbug. We must guard against too sudden a delivery, with 
membranes, water, and after-birth altogether, as that is very 
apt to be followed by haemorrhage. After the delivery of the 
child, lay it on the right side, remove any mucus from its 
mouth, and give it a very gentle beat on the back with the 
open hand. Usually this is sufficient to establish respiration ; 
if not, artificial respiration, or otherwise, should be resorted to — 
(see Asphyxia). Respiration may be suspended for over forty 
minutes, and resuscitation may take place ; so our efforts should 
continue as long. 



CHILDBIRTH. 709 

As soon as the child cries lustily, and there is evidence of a 
proper suppty of arterial blood, that is the time to ligate the 
cord, applying the first ligature from three-fourths to one inch 
from the belly, the other one two inches further on, and then 
dividing or cutting it between the two. As soon as this is 
done, wrap or roll up the child in a blanket, and hand it to 
the nurse ; then attend to the mother, and the removal of the 
after-birth. On placing your hand over the abdomen, you will 
find the uterus either contracted or relaxed. If contracted, the 
after-birth may be in the vagina, and a cough, or sneeze, or 
blowing with some force into the palms of both hands, or a 
gentle bearing-down effort, or slight traction on the cord, may 
cause it to come away. As soon as it approaches the vulva, it 
should he grasped and twisted round several times, so as to 
twist the membranes, and have them come easily and entirely 
away. 

If the uterus is relaxed, and after-birth attached, resort to 
frictions with oil over the abdomen, so as to cause contraction ; 
allow a little rest till the vital forces rally. Administer a little 
capsicum in warm sweet milk, or a little quinine, or a little 
hot punch, so as to establish permanent tonic contraction of 
the uterus. If there is retention of the after-birth after tonic 
contractions have taken place, use friction, shampooing, dry 
heat to the abdomen, enemata of tepid water into the rectum, 
and administer stimulants. These means failing, after waiting 
perhaps one or two hours, introduce the hand in the form of a 
cone — the back of it well oiled — into the cavity of the uterus, 
and gently grasp the placenta, or after-birth. It is very prob- 
able that the presence of the hand will cause such violent con- 
tractions, with expulsive pains, as to cause it to be thrown off. 
If not, detach it carefully, and leave no portion behind ; wait 
until a pain comes, when withdraw the hand in harmony with 
the bearing-down effort. This is best effected with the patient 
on her back, knees drawn up — and I will repeat, let it be done 
with great kindness and gentleness. After it is removed, the 
patient should be carefully bandaged, from the middle of the 
thighs to the bottom of the sternum, with a thin compress over 
the uterus. In applying this bandage, it should be pinned 
from below up ; a pin every inch, and free from all wrinkles. 
Then a dr} 7 , warm diaper should be pressed against the vulva. 
This, or a similar bandage, should be applied daily, and seen 
to by the physician or nurse for ten days, and it should be worn 
for at least two or three months. On the re-application of the 
bandage, it is well to sponge the abdomen with a little harts- 
horn and tepid water; dry off well, and then use either bay 
rum or cologne-water. By this means all the cracks, fissures, 
crevices, of the abdomen are avoided ; abo enlarged or pendu- 



710 CHILDBIRTH. 

lous abdomen. A woman can be well preserved if due care 
is taken of her, even after she has had a dozen children. 

After the bandage is applied, the patient should be moved 
up to her proper place in bed, and a doubled quilt placed under- 
neath her. The use of the bandage after delivery has many 
advantages. Besides maintaining the natural condition of the 
abdomen, it stimulates the uterus to contraction, and thus pre- 
vents haemorrhage ; it rests the broad ligaments, and gives sup- 
port, and prevents falling of the womb ; it is, besides, a great 
safeguard and comfort to the woman, and on no account can it 
be dispensed with. Always pin from below up, firm at first, 
but always easier as you progress upwards. 

If there is any disposition to haemorrhage, in addition to the 
roller put the child to the breast at once, or as soon as possible 
after the mother has rested. The first cathartic should be given 
after the mother has had a sleep; and it should be oil, on account 
of its influence in secreting milk. All through, during and 
after labor, the bladder should be carefully watched, especially 
if there is any retention of urine. 

The diet of the mother, if not very feeble, should, for about 
nine days, consist of plain oatmeal gruel, sago, arrowroot, rice, 
tea and toast, beef-tea. As a rule, beef, mutton, chicken, game, 
or high-seasoned food, or stimulants, should be avoided ; but 
after the ninth day, a generous and nutritious diet may be 
allowed, even as liberal as the patient may desire, avoiding all 
indigestible articles, as veal, pork, salt meat and fish, pie-paste, 
cabbage, etc. 

The discharge that comes, or takes place from the uterus after 
delivery, is called the lochia, or cleansing, and should continue 
from two to three weeks ; if longer than three or four, means 
should be taken to tone up the uterus by port wine and Peru- 
vian bark, mother's cordial. If it should suddenly cease inside 
of the first two weeks, measures should be taken to re-estab- 
lish it. 

The most common causes that are likely to cause its arrest, 
are cold, cold drinks, ice ; sudden mental emotion, or excite- 
ment, or worry, or passion. 

To cause its re-appearance, try heat to the vulva, over the 
uterus, and to the feet, with infusion of catnip, and a few drops 
of the tincture of aconite. If that fail, try serpentaria com- 
pound, in half-teaspoonful doses, in some warm tea, and ad- 
minister enemata of flaxseed tea, with laudanum. If that fails 
let patient drink linseed tea, warm, with tincture of snake- 
root. If the stoppage, or arrest of the lochia takes place in- 
side of the first ten days, we may entertain apprehension of its 
absorption into the blood, and puerperal fever ; later than that 
it is not likely to be attended with such grave results. The 



CHILDBIRTH. 711 

prevention of its disappearance, by keeping the patient quiet, 
free from all care or anxiety, by a strict avoidance of all cold 
drinks, and inculcating other elements of comfort, which are of 
great consequence, will almost infallibly ward off this compli- 
cation. 

The uterus may, if ergot or forcing-powders are being ad- 
ministered, contract on the after-birth, the mouth and neck 
close, and the lochia cease. This is a bad state of affairs, in- 
duced by the action of this drug, to whose use many mothers' 
lives have been sacrificed. The ergot stimulates the lower por- 
tion of the spinal cord, and thus contracts the entire uterus, 
neck and all, beside rendering the blood clotty. 

If this should occur, administer opium freely to relax the 
neck and mouth of the uterus ; throw up tepid or warm enemas 
into both vagina and rectum ; scorching hot pillows to the 
loins ; heat over uterus. If not successful in getting the fingers 
in after it, try inhalation of a few drops of chloroform on a 
towel — not enough to cause anaesthesia, because the blood is 
thick and heart feeble. If not successful then, try a warm ene- 
niata of lobelia, and administer lobelia in small doses, not 
enough to vomit but to nauseate well, and then try to remove 
it. This failing, try belladonna and opium pastiles and sup- 
positaries ; they not successful, inject the uterus with a strong 
infusion of chamomile flowers and borax. That failing, leave 
a catheter in the uterus for a few hours, well up to the fundus, 
so as to try and originate pains or contractions. If all means 
fail in this crisis then inject the uterus thrice daily with a tepid 
injection of water and permanganate potassa, and see that it 
all escapes ; and keep the patient under opium. 

Retention of the Placenta is a grave affection, there being 
great danger of blood-poisoning, metro-peritonitis and puer- 
peral fever. It may be remarked that, as a class, our women do 
not bear injections into the uterus well, and they in themselves 
are dangerous from the injection finding its way into the uterine 
sinuses, thence into the blood, and causing death by producing 
acute, fatty degeneration of the liver. 

Every resource must be brought to bear on the case : if one 
or two fingers can be inserted there is no trouble, aided- by the 
lobelia and belladonna, both by vagina and rectum, and inter- 
nally. 

Hour- Glass Contraction of the uterus and retention of the 
after-birth, is also quite common, and in a great measure is 
due to the use of ergot in labor. Hour-glass contraction is a 
condition in which some nerve that supplies the middle of the 
uterus is weak, and where it receives an undue amount of stim- 
ulation or irritation from the cord, irritated by ergot, which 
causes it to contract in the centre with the after-birth in its 



712 CHILDBIRTH. 

upper half. This is not so grave an affection as the contraction 
of the os and neck, because when the system is well-relaxed 
with lobelia enemata and internally, if necessary, it readily 
yields, and by gentle manipulation, one finger and then another 
can be inserted, until the whole hand gets through the obstruc- 
tion, and seizes the after-birth and withdraws it. Treat same 
as Retention. 

Can it be wondered at that we have so many complications 
of labor, when so much ergot, or forcing-powders are given ? 
Our women, the best nurses in the world, are spoiled, their 
milk rendered scanty, insufficient, or none at all, by the system 
of senseless drugging during labor. It is not the women, but 
the utter incapacity of the physician that is at fault. Even the 
infinitesimal pellets contain enough of ergotine and atropine 
to give rise to untold trouble. 

The breach, or the feet, knees, buttocks, are regarded as nat- 
ural, and are next in frequency to the head, but they are not 
such good points for dilatation ; consequently, the labor is very 
slow or prolonged, and even when the feet, knees, buttocks and 
body are expelled there is danger to the child, if the head is 
not delivered, by pressure upon the cord. If flooding should 
take place during natural labor, enjoin rest, horizontal position, 
and a plug. If these means fail, endeavor to excite uterine 
contractions with quinine, capsicum, corn-smut, mistletoe. If 
still persistent, and the os uteri dilatable, rupture the mem- 
branes and introduce the hand into the cavity of the uterus, 
seize the feet and bring them down with their toes pointing 
to either thigh of the mother, so as to bring the long diameter 
of the head into the long diameter of the pelvis. 

In convulsions during natural labor, if the mouth of the 
womb is rigid, administer opium and lobelia, by the mouth 
and by enemata ; if they recur, inhalation of chloroform ; and 
as soon as the mouth is dilated sufficiently to admit the hand, 
insert it, seize the feet, and bring down, with the toe« pointing 
to either thigh ; and deliver under chloroform and hypodermic 
injection of morphia. 

If fainting fits should occur, and they are due to debility, or 
some peculiarity of the nervous system, diffusible stimulants 
should be given ; but if they are due to internal haemorrhage 
(concealed), turn and deliver. 

If there is a rupture, and danger of strangulation, and the 
mouth of the womb is dilatable, turn and deliver. 

In some cases the after- birth, instead of being located at the 
fundus, is implanted right over the mouth of the uterus. If an 
attendant in the family, the mother generally calls attention 
to it as early as the fourth month, by a dribbling or oozing of 
blood, which increases in frequency and quantity as the neck 



CHILDBIRTH. 713 

of the womb merges into the body during the later months, 
and at full time it is quite considerable. On making an exam- 
ination with the finger, a soft, spongy mass can be detected over 
the mouth of the womb. In all such cases it is well to have 
another physician in attendance besides the regular one, -not 
for aid, but to share the grave responsibilities of such a case. 
Wait until labor sets in ; if there should happen to be hsemor- 
rhage, use the plug made of several fine sponges until the 
mouth of the womb is sufficiently dilated to admit the hand ; 
then push away the after-birth on one side, whichever yields 
most readily ; then insert the hand, rupture membranes, and 
brine: the feet down, toes to the thigh of the mother. Before 
resorting to this, either brandy or capsicum should be given, 
with infusion of good, fresh ergot ; the abdomen rubbed with 
warm oil, and every means taken to facilitate delivery. Prompt- 
ness of action and a clear head are necessary in this crisis, in 
order to save either mother or child. When turning is once 
consummated, there is little of further haemorrhage, because 
the head of the child effectually blocks the mouths of the bleed- 
ing vessels. If no physician is near, the nurse or midwife must 
pursue the above course, without aid, for if she waits, death 
will inevitably take place. There should be no interference 
until the mouth is dilated to admit the hand, only by the plug, 
but everything be in readiness. 

In case of presentation at the shoulder-joint, it is easily recog- 
nized by the child lying crossways in the abdomen, head at 
one side, buttocks at the other, by the sharp point of the shoulder 
or the descent of the arm. In cases of this kind, delivery can- 
not take place, and it is necessary in all cases toturn. So wait 
until the mouth is sufficiently dilated to admit the hand ; then 
rupture the membranes, if still entire, and proceed to turn. In 
doing this, the patient should be placed upon her back, knees 
drawn up ; the back of the hand of the operator well oiled ; 
hand in the form of a cone, gently introduced into the cavity 
of the womb ; seize the feet and bring down, with the toes point- 
ing to either thigh of the mother. If the hand of the child 
has descended, the palm will either point to the front or the 
back ; this forms an excellent guide to where the feet are to be 
found. If it points to the front, insert the hand up in front, 
and there the feet are to be found ; if to the back, then in that 
direction. This saves groping round after the feet. In all 
cases of turning, or when it is necessary to introduce the hand 
into the uterus, it should be done during the absence of a pain ; 
and if a contraction or pain comes on when it is so introduced, 
let it lie flat until the pain subsides, and then proceed and bring 
down the feet. 



714 CHILDBIRTH. 

After-Pains. — After the first confinement it is unusual to 
have after-pains, as the uterus does its work with energy, and 
there is nothing left in it ; but after all subsequent deliveries, 
the uterus is likely to suffer some inertia, and there is apt to be 
a clot, or a retained bit of placenta, or something which the 
uterus wants to and tries to expel. It is not to be regarded as 
a disease, but a healthy condition of the womb. The womb is 
doing its duty, and, as a rule, if the clot is not very large, the 
pains are not very severe ; but if of great size, then there is 
considerable pain. There is another condition: a diseased 
state, in which the recently emptied uterus goes into a most 
violent and painful contraction, without any discernable object 
in view ; and a severe case of this kind is bad — much more 
painful than ordinary after-pains, that come on to expel a clot 
or piece of membrane. 

In all cases of after-pains, whether mild or severe, the roller 
should be kept applied, but not too tight, as it acts as a stimu- 
lant to contraction. Opium or morphia, with extract of hyos- 
cyamus, should be given, so as to relax the neck of the uterus; 
it should be administered guardedly, just enough to relax to 
permit the egress of the clots, discharge, or cleansing, and dis- 
continued as soon as possible. It is best given with some 
diaphoretic tea, as catnip, or sweet marjorum, or pleurisy root, 
or boneset, whichever is most handy. If still persistent, evacu- 
ate the rectum by first administering a large dose of castor oil, 
with twenty or thirty drops of tincture of opium, and enemata 
of the same. There is scarcely a possibility of a case resisting 
these measures. Still, if there is, compound tincture of serpen- 
taria could be given, and dry heat applied over the uterus. 
Better not to give many remedies, as they so influence the 
secretion of milk. 

The Forcing-Powders in Labor. — If there is a drug that 
should be proscribed or forbidden in or during labor, it is ergot. 
It is called the forcing-powder, as it is customary to administer 
it in that shape in hot water or tea, because it is more active in 
that form. Few doctors or mid wives give the wine or fluid 
extract. There can be no doubt of its action in inducing uterine 
contractions; but its effect on the blood is highly deleterious, 
causing embolism of that fluid, and often sudden death after 
delivery, besides giving us an alarming increase of still-born. 
There are now so many excellent substitutes, free from all pos- 
sible objections, that we can afford to lay it aside. For example, 
sulphate of quinine, capsicum in warm tea or milk, the corn- 
smut, caulophyllum, external stimulations with oil, or with 
the battery. Every possible means of increasing the vital action 
of the uterus should be tried before risking such a remedy in 
the blood of a parturient woman. 



CHILDBIRTH. 715 

Abortion. — The expulsion of the foetus from the uterus before 
the sixth month, is called abortion ; after that period, prema- 
ture labor. 

The causes are numerous and variable, as violent mental 
emotion, fright, passion ; the effect of habit; disease, as diarrhoea, 
dysentery, fevers, disease of the heart, syphilis, acute disease of 
any kind ; excesses, sexual or otherwise ; violent exercise, racing, 
jumping, blows, causing inflammation ; drugs, as sabina, aloes, 
quinine, iodide of potassa, borax. Thickening of the neck of 
the uterus is a common cause at four and a half months. 

The ordinary signs of abortion are: a disappearance of the 
morning-sickness, naccidity of the breasts ; tenesmus, or bearing- 
down; symptoms of labor, expulsive pains, and haemorrhage. 
This last symptom cannot exist without a partial separation of 
the after-birth. A rigor, which is almost invariably present in 
labor at full time, often takes place here, and in some cases 
with great violence. 

To prevent abortion, enjoin rest, quietness, freedom from care 
and anxiety, recumbent posture, strengthening treatment, cold 
infusion or fluid extract of the black haw, or port wine and 
Peruvian bark; opium is the remedy to arrest uterine contrac- 
tions. No plug of sponge, or any other body, must be intro- 
duced into the vagina unless there is excessive haemorrhage, 
as its pressence excites uterine contractions and expulsion of 
the contents. 

Missed Abortion. — This is not a threatened abortion, nor 
an imperfect abortion. Threatened abortion is very common 
at four and a half months, especially if there is the slightest 
thickening of the neck, for when it begins to stretch and 
emerge into the body, if there is resistance, there will be irrita- 
tion communicated to the fundus and contractions. When a 
woman has threatened abortion, she suffers pain, has a bloody 
discharge, and mouth of the womb is opened. An abortion 
may be threatened and averted, and pregnancy go on in a 
healthy way. There might be an abortion in the case of twins, 
one aborted and the other remain, and one go on to develop- 
ment. The abortion of one of the twins may be a missed abor- 
tion, or the miscarriage of one may be a missed miscarriage. 

If the foetus alone, or the entire ovum alone, comes away, the 
woman has miscarried, or aborted ; it may not be complete, 
but imperfect. The ovum may come away alone, without the 
membranes, or the after-birth ; or only a portion come away. 
This is always dangerous, as it is liable to give rise to haemor- 
rhage or else lead to putrid absorption. This is especially 
liable to be the case if the abortion has been caused by instru- 
ments or drugs, for then there is always less or more endo- 



716 CHILDBIRTH. 

metritis. Imperfect miscarriage invariably induces endome- 
tritis in subsequent life. 

When a woman has a missed miscarriage, or abortion from 
a fright or blows, the natural course of events are as follows : 
The foetus dies, the symptoms of pregnancy are arrested, milk 
may appear in the breasts, there may be a bloody oozing from 
the uterus, or otherwise ; if the waters are not dried up, they 
are absorbed, and the contents of the uterus shrivels up and 
becomes mummified. If the membranes remain entire, ab- 
sorption is the rule, with mummification. The uterus steadily 
diminishes in size, but its contents remain and continue up to 
the full time, when they are expelled. The expulsion is fre- 
quently unexpected; happens while standing or defecating, 
and the mass shrivelled up in a bundle, or rolled up in a parcel, 
is expelled. The mass is usually fresh, of a brown color, and 
contains the foetus in the centre. 

When such a case as the above is clearly made out, the intro- 
duction of a catheter, or catgut bougie, into the uterus for sev- 
eral hours, so as to excite contractions, together with quinine 
and caulophyllum to stimulate uterine energy, is indicated. 

Foeticide. — The moral atmosphere of the American female 
is tainted by a varity of causes, habits, association, system of 
living ; laziness, amusements, and literature. The latter es- 
pecially is exercising a baneful influence on her ; our modern 
periodicals and dime novels, the press, that great engine of 
thought, progress and vitality, sways a corrupt, reckless, and 
unscrupulous influence, and aids her demoralization by adver- 
tisements, and otherwise ; nay, may be regarded as irreverent, 
offensive, and profane ; an eating ulcer in the female economy, 
— fostering a state of things that is sapping the very vitals of 
our country — one of the most serious and sinister symptoms 
of general national decadence. Married women trying to es- 
cape the cares and responsibilities of mothers, betokens a seri- 
ous derangement in the body politic, and more so when the 
entire force of female character is permeated with this one idea, 
and our clergy powerless to stem this current of national crime. 
The number of abortions committed in our large cities is enor- 
mous ; the uninitiated can have no conception of the immens- 
ity and gigantic proportions of the crime. Out of the eighty 
thousand so-called physicians in our country, one-half, at least, 
are either open or concealed abortionists. There is no crime 
so common as foeticide ; even some druggists and herb dealers 
could not maintain an existence but by selling drugs to pro- 
cure abortion. The crime prevails largely, and enters like an 
eating worm into every condition of society and threatens our 
very existence as a nation. The abortionists are plying their 
fearful calling with frightful activity, and measures should be 



CHILDBIRTH. 717 

taken to arrest it. Our people should be instructed regarding 
the sanctity of ante-natal life, and the fact that there is no dis- 
tinction in the turpitude of the crime. of the destruction of 
ante-natal, or post-natal existence. The induction of criminal 
abortion should be made a capital crime, and any one who 
knows of its commission, made accessary to it. 

The induction of abortion is only legitimate when the life of 
the mother is imperilled by a continuance of pregnancy; that 
the emptying of the uterus presents itself as the only alterna- 
tive to save her. 

Abortion is the most terrible calamity that can befall a preg- 
nant woman, and it is doubly worse when brought about by 
malpractice ; the number of morbid conditions that follow it 
are beyond all calculation. The following maybe enumerated 
as a few results that are likely to follow : It gives rise to a habit 
which nothing can overcome; it causes painful sitting, painful 
sexual connexion, intrauterine catarrh, catarrh of the neck, 
falling of the womb, neuralgia of the ovaries, nerve-exhaustion, 
aching kidney, irritable bladder, ulceration of the uterus, cancer. 

Ulceration of the internal cavity of the uterus is a frequent result 
of abortion. The ulceration follows a previous condition of 
villosity; the villosity is destroyed and ulceration takes its 
place, or it may begin with ulceration. It is not common in 
the young, but in the old, the result of abortion. There are 
slight bleedings, w T hen the ulceration extends into the cavity of 
the uterus. If seen early, treat it the same as inversion of the 
fundvj, by touching it with tincture of iodine and iodide of 
potass. 

Hematocele. — A tumor composed of blood, and enclosed, is a 
fatal result of the above condition. The blood escapes in various 
ways, and causes death. 

Cancer a Natural Result of Repeated Abortions. — We have else- 
w T here called attention to cancer of the body of the uterus ; but 
the pre-eminently glandular organ, called its neck, and the 
internal mucous membrane, are the most frequent seat of cancer 
of the female genital organs. 

The great malignant disease of the cavity of the uterus is 
adenoma, & malignant glandular growth of the mucous mem- 
brane, which sprouts forth, and bleeds, and grows, and distends 
the cavity of the uterus, and fills it up ; passes through the 
cervix, and grows into the vagina, and protrudes at the orifice 
of the vulva, the whole mass being composed of adenomatous 
tissue. It is often mistaken for a polypus, or a mere mucous 
outgrowth or vegetation. 

Bloody Tumor of the Labia. — The pressure of the head or of 
instruments is very apt to cause an extravasation of blood into 
the labia. Cloths saturated with the distilled extract of witch- 



718 CHILDBIRTH. 

hazel, or tincture of arnica and water, or marigold ; and if not 
speedily relieved, apply a lotion of lime-water and tincture of 
iodine, or muriate of ammonia. 

Inflammation of the Vagina is a rare affection. If it should 
occur, injections of linseed tea and opium; slippery elm and 
opium, with opium and gelseminum internally, same as Peri- 
tonitis; absolute rest. 

Puerperal Fever. — (See Child-Bed Fever.) If due to suppression 
of the menses, or retained placenta, wash out uterus once or 
twice daily with tepid water and permanganate, or withborax ; 
and treat fever same as Metro- Peritonitis. 

Laceration of the Perinxum. — The greatest care should be exer- 
cised to prevent the slightest tear or laceration of the perinseum, 
by affording proper support; by applying hot cloths, to relax; 
wrung out, either of hot water or infusion of lobelia. It is 
most liable to occur in hurried labors, with forcing-powders, 
or from the reckless use of instruments. If it should occur, the 
lochia is a great barrier to union, preventing the parts from 
uniting. As soon, however, as the lochia disappears, the torn 
edges should be carefully pared, and sutures or stitches inserted, 
the legs tied closely together, and a catheter inserted into the 
bladder. If the laceration is extensive, it ma}^ be necessary to 
resort to quilled sutures, to keep the parts in perfect apposition. 
This stitching is better to be done at once, for if allowed to 
remain, it has a depressing effect on the patient's mind, and it is 
a condition not at all favorable if prolapse of the uterus should 
take place. 

Vesico- Vaginal Fistula. — A fistulous opening from the 
bladder into the vagina. 

Its common cause is the use of instruments during delivery, 
especially if the bladder has not been emptied. A full or dis- 
tended bladder, with hurried labor, or with a bad presentation, 
or a crooked or deformed pelvis, may also give rise to it ; and 
various other like conditions. It is often caused by ladies 
attempting to commit abortion on themselves by knitting- 
needles, whalebones. The dribbling of the urine through the 
orifice, night and day, gives rise to irritation, rawness of the 
vagina, and renders the patient very miserable, and an object 
of great distress. 

It should be treated by getting her into as good health as 
possible, and then stitching it up ; placing her upon her arms 
and knees, head down, parts well exposed by two crow-bill 
speculums, a catheter in the bladder. The edges of the fistula 
should be well pared, and then stitched up with lead-wire 
sutures ; natient put to bed, and a catheter kept constantly in 
the bladder. All cases are successful. 



CHILDBIRTH. 719 

Recto- Vaginal Fistula. — This may originate from a lacera- 
tion of the perinaeum, which extends back through the sphincter 
muscle of the rectum, which has been stitched up, but left an 
opening between the vagina and rectum ; or it may have arisen 
from chancre in the vagina perforating through, or from stric- 
ture of the lower bowel, foreign bodies ; from the introduction 
of knitting-needles, whalebones, to induce miscarriage ; and 
like conditions. 

It is easily recognized by the passage of gas, liquid, or solid 
faeces into the vagina. If very small, and in doubt, empty the 
bowels from above with castor oil ; after it has operated, put 
patient on her back, knees drawn up, and a crow-bill speculum 
into the front part of the vagina ; have a good light, and the 
index finger into the bowel, and examine it all over for an 
orifice. They are seldom high up, and by bulging the rectum 
with the finger, can be easily seen. If very small, so that a pea 
would penetrate through, it can be closed up without an opera- 
tion if carefully managed. Every second or third day for five 
or six weeks it can be touched with nitric acid ; that is, the 
edges of the fistula and a little beyond ; after it is raw, it will 
begin and throw out granulations that will effectually block up 
the orifice. It takes time and care, and while it is going on, the 
patient must keep bowels very soluble and free from gas, by 
eating a proper diet. If it fails, or if the opening is large, it 
should be stitched up. Patient's bowels having been well 
cleansed out, placed under chloroform on her back, a crow-bill 
speculum should be inserted, and the part exposed to a good 
light ; its edges should be freely pared, so as to have a good 
raw surface. If the sore is round, like a three-cent silver piece, 
it has to be lengthened slightly, to prevent puckering when the 
stitches are introduced ; then sewed up with lead sutures ; and 
the sphincter muscle on both sides of the coccyx must be divided, 
so that the patient can have no control of the bowels, that gas 
and solid matter may pass without disturbing the fistula ; bowels 
locked up for ten days with opium ; and kept perfectly quiet 
in bed for two weeks. If the patient is strong and vigorous, 
all may go well ; the cut sphincter may unite ; if it does not, 
the patient is a miserable object all her future life, not being 
able to hold or have control over her bowels. The original 
fistula, however, unites perfectly, unless there has been some 
bungling in the paring of the edges or application of the stitches. 

To obviate the cutting of the sphincter muscle of the rectum, 
tubes have been tried, with partial success. 

In all cases the best of nourishment should be given, so that 
a high standard of health be maintained. 

Puerperal Mania, or Madness, is generally the result of a 
tedious labor, with the head embedded in the cavity of the pelvis, 



720 CHILDBIRTH. 

pressing heavily upon the sacral nerves. The easing up of the 
head often relieves the difficulty. If not, delivery should be 
hastened, and then the case treated with anodynes, cups to the 
nape of neck, and enemata of lobelia and hyoscyamus. Bro- 
mide of potass and chloral hydrate should be freely ad mistered. 
If she be altogether unmanageable, hypodermic injections of sul- 
phate of morphia, with inhalation of chloroform at intervals of 
every two or three hours ; bowels freely opened from above. The 
pressure of the head on the sacral plexus, even for a short time, 
the irritation is transmitted to the brain, a temporal form of 
mania is induced, which passes off; even that must be seen to. 
The condition is often much aggravated by. worry, exhaustion, 
want, haemorrhage, or debility — (see Puerperal Mania). 

Puerperal Convulsions, — These are of different kinds, the 
original cause in them all being an irritation transmitted to 
the nerve centres. For treatment, it is a good plan to divide 
them into two classes — those in which there is anaemia of the 
brain, and those in which congestion predominates 

In both forms, turn, and deliver with ail speed, if the mouth 
of the womb is dilatable. 

If due to anaemia, hypodermic injections of morphia ; lobelia 
enemata, and very nourishing drinks; or use inhalations of 
chloroform or chloral hydrate, with the hypodermic injections. 

If due to congestion, enemata of lobelia, active purgation, hy- 
oscyamus, bromide of potassa; heat to feet, stimulants to nape 
of neck, cups ; all failing, administer either by mouth or rectum 
the antispasmodic mixture, which is a safe and always effica- 
cacious remedy. A division of the class thus enables you to 
meet them with great promptness. 

Puerperal Peritonitis. — This rarely occurs without inflam- 
mation of the uterus first, then its peritoneal covering, and 
latterly, the entire membrane, closing with gastritis and death. 
The predisposing cause in all those cases is depression of the 
sympathetic system. The exciting cause, some injury to the 
uterus, or absorption of the after-birth, or lochia (see Peritonitis 
for treatment). 

Milk Fever. — Usually comes on by rigors, pains in breasts, 
thirst, fever, soreness of abdomen, often slight delirium, arrest 
of secretions of milk, and lochia — (see Ephemeral Fever). 

Milliary Fever. — We sometimes have the same form of fever 
with a milliary rash, which runs along for over a week — 
(same as for Ephemeral Fever). 

Rupture of the Uterus. — This is very apt to take place if 
there is any obstruction, hardened faeces, an exostosis of the 
promontory of the sacrum, deformed pelvis, a bad presentation, 
turning during a pain, or the use of ergot during the first 
stage, and such like causes. Some think fatty degeneration of 



CHILDBIRTH. 721 

the muscular fibres of the uterus has much to do with it, and 
thinning of its walls. It is easily recognized by the sudden 
cessation of pain, fainting, pallor, death-like coldness, and, on 
placing the hand over the abdomen, the child can be detected 
in the cavity of the abdomen out of the uterus. 

If such an event should take place, the abdomen should be 
slit up, its cavity exposed, the child, after-birth, blood, clots, and 
water carefully sponged out, the cavity of the uterus cleansed, 
the whole stitched up and bandaged. An effort should be 
made to rouse up the patient by the administering diffusible 
stimulants; and if she rallies, treat like Metro-Peritonitis. 

Aching Kidney. — This is very common in women after 
abortion from a lift or strain. One or both kidneys may be 
the seat of the ache. The pain is heavy, wearying, deep in 
the side over the region of the kidney, or in the kidney itself. 
The pain in some cases is boring like a nail. There is often 
associated with this pain a corresponding ache in the limb of 
the affected side; it is also frequently accompanied with irri- 
table bladder. It is most common about the monthly periods, 
but has nothing to do with painful menstruation, but is more 
likely to take place after delivery or abortion. The left kidney 
is more frequently the seat of ache than the right ; in very 
rare cases can either a tenderness or fulness be detected. The 
case is essentially one of debility, and requires rest and tonics, 
as uva ursi and tincture of iron, capsicum, or other stimulating 
applications. Albuminuria ma} r exist in the urine, with aching 
kidney, and if it does it is likely to give rise to the death of 
the foetus and abortion. 

Coccyodynia ; or, Nenralgia of the Coccyx. — Pain, ten- 
derness about coccyx ; often sharp, tearing, lancinating ; is a 
most unpleasant form of neuralgia. Most common in women, 
on account of their great development of coccyx, and above all, 
in women of high civilization, who have as an index of that 
condition a sacrum at an angle well verging on to 45°, and 
a coccyx most perfect. In women of low civilization the sacrum 
is nearly straight, and the coccyx almost as rudimentary as it 
is in man. 

Causes. — Hurried labor, or insufficient support to the perin- 
seum, whereby the nerves of the coccyx receive a shock ; 
blows, falls, fractures, and horseback exercise, etc, 

Symptoms. — Pain in sitting down or in rising, or in walk- 
ing, or in defecating. Pain is even more than neuralgic, more 
than sharp and lancinating; there is a general soreness. In 
many cases patient can only sit on one hip. Any movement 
or pressure on the surrounding parts give rise to pain. It is 
aggravated by menstruation, or sexual intercourse. It may be 



58 



722 CHILDBIRTH. 

reflex, as in chronic inflammation of uterus or ovaries. It is 
very chronic in its nature. 

Treatment. — Remove all sources of irritation about uterus, 
ovaries, rectum. Place patient upon a general alterative and 
tonic course of treatment, with the best of food. Keep bowels 
open with cascara ; suppositories of belladonna and opium at 
bedtime, or hypodermic injections. 

To raise the standard of vitality in the nerves of the coc- 
cyx, warm hip-baths, quinine, iron, pulsatilla, glycerite of 
kephaline, and other nervines, such as musk, valerian. 

Painful Sitting. — In coccyodynia, as a result of fracture.of 
the hinge-joint, alter ossification, in having a child after thirty- 
five years of age, there is apt to be a laceration of the nerves, 
and neuralgia established, which gives rise to painful sitting. 

This is also present in deep-seated inflammation of the geni- 
tal organs, especially in the uterus and ovaries, so very slight, 
however, that the patient does not experience uneasiness, only 
in the sitting posture. 

Relaxation of the great joints of the pelvis towards the end 
of pregnancy is very natural; they become loose and juicy, 
and a considerable increase of motion is observed in them. If 
the labor is long, the presentation not a good one, or the head 
of the child large, or instrumental delivery, made with force or 
violence, there may be a low grade of irritation set up in them. 
So that there is a morbid loosening, which not only gives rise 
to pain in sitting, but hopeless lameness. Rest, general alter- 
ative, and tonic treatment will, in time, effect a cure. 

Other Morbid States Co-existent with Childbirth. — With 
regard to the mental relation and its disorders, the rule is, that 
women, having children for the first time, over twenty five, 
thirty, thirty-five years of age, are more liable to attacks of 
insanity than when younger. Cases of insanity arising during 
pregnancy are smaller than after delivery. Melancholia is the 
most common form occuring during, or associated with child- 
birth. We are utterly opposed to the practice of those who 
advise pregnancy in cases of insane women, when ordinary 
remedies fail to do good. 

Pregnancy is not incompatible with carcinoma, syphilis, 
epidemic and infectious diseases, and forms a grave complica- 
tion. As a rule, conception temporarily arrests phthisis pul- 
monalis, but never cures that condition. The marriage of 
persons so affected is contrary to the general welfare of a people. 

In, during, and for six weeks subsequent to childbirth, the 
most rigid antiseptic precautions should be observed. The 
lochial discharge is a mass of disease-germs (bacteria), and its 
septicemic properties should be promptly destroyed. Body 
bedlinen immersed in sulphurous acid water. 



THE CHILD — ITS DISEASED 723 



THE CHILD-ITS DISEASES. 



THE CHILD. 

One of the greatest wants of the age is health — " a sound mind 
in a sound body." Without it our national future — the future 
of families, of races, becomes more a matter of chance than a 
certainty. Physical degeneracy has blotted out many names 
from the face of the earth that ought to have been perpetuated 
to bless and take part in civilization and progress. Many pa- 
rents bring into the world feeble children, because the laws of 
life and growth were not understood. Many more have con- 
signed their loved ones to an early grave, or had them afflicted 
with disease, feebleness, deformity, through a want of a knowl- 
edge of the natural laws of life. It is a true maxim, that a 
large and healthy population is the life and. strength of a nation, 
as well as the source of its success in sciences, arts, agriculture, 
commerce; so that it is a point of momentous importance to 
secure to the child a perfect state of health. It is true that 
pure air, cleanliness, suitable clothing, plain, natural food, will 
do much in preventing disease and prolonging life. Marriage 
should be prohibited among persons of like temperaments, or 
diseased, as they produce a diseased offspring. Neither should 
there be any incompatibility of ages, of blood affinity, or dis- 
position. In order to do her duty to herself, to her country, to 
her offspring, a pregnant mother should sustain her health in 
its highest perfection. This she will accomplish by attention 
to diet, clothing, cleanliness, exercise, and moral discipline. 

Her diet should be simple, light, nutritious, with abundance 
of brain, bone, and flesh-forming elements, adapted to the 
requirements of the individual and the condition of the digest- 
ive organs. The clothing should be warm, comfortable ; all tight 
lacing, corsets, etc., should be avoided. Keeping the skin in the 
best of order, by daily tepid sponging, is very conducive to 
good health during gestation. Gentle, moderate exercise is to 
be recommended, and all violent movements avoided. She 
should live in well-ventilated rooms, so as to breathe pure air 
at all times. There should be a perfect state of mental and 
bodily equilibrium on the part of the mother on all occasions ; 
a well-balanced state of all her emotions, desires, affections, 
passions, ; her mind calm, cheerful ; there should be no strain 



724 THE CHILD — ITS DISEASES. 

either on the intellectual or physical, especially on the former. 
She should entertain a high sense of her social duties, of her 
eminent status in nature as the mother of our race, and have 
implicit trust in Him whose name is honored in his marvellous 
works. The mother is all in all ; her mental condition stamps 
the character, the calibre of the future man, the future mental 
condition, sex, and capacity of an immortal being; so that 
every precaution should be taken to look well to the mother. 

At the moment of impregnation, both parents, to a certain 
extent, transmit their qualities to the offspring; and either 
parent may transmit, to a greater or less degree, their constitu- 
tional peculiarities, thus occasioning the greater or less resem- 
blance to one or other parent. But from the moment of con- 
ception until birth, and even during lactation, the influences 
of the mother are constant. She is specially present ; to her we 
owe all, even the determination of the sex. The natural tend- 
ency of a healthy mother is to breed a great excess of male 
births. This she can only do under certain conditions, to wit : 
saving her mental forces for perfect production. One would 
naturally think that by education and improvement of mothers 
in the sciences and arts, that we would improve the stock, and 
further increase male births, which is true, if the mother does 
not exercise, or exhaust, or overwork her intellectual powers 
during the breeding period of life. If a woman, betore and during 
the child-bearing period of married life, becomes an astronomer, 
teacher, preacher, physician, attorney, she exhausts her man- 
hood, and cannot bear male children at all, or if she is capable 
of giving birth to boys, they will have small heads, weak brains, 
feeble or meagre intellectual capacity ; in other words, they are 
deteriorated and effeminate. So that if married women crowd 
the avenues of scientific life, before and during the child-bearing 
period, we run the risk of becoming a nation of girls. 

Anything that affects the mother injuriously or depressingly, 
to the same extent damages the child. Let the mother partake 
of gross food, and there is a strong probability that the child 
will be tubercular; if she is of sedentary habits, it will be 
weak and flabby ; if she has been dosed with drugs, they will 
impair the constitution of the child. And so, with mental 
influences — if she has contemplated foeticide, the future child 
will have suicidal mania ; if she reads trashy novels, they will 
react on the offspring in some vice ; if she is passionate, has an 
unhappy home, or bad husband, each one, or all, will give rise 
to some deterioration in the child. So that if we want healthy, 
buoyant children, free from all disease or immoral taint, we 
must have happy, comfortable mothers. 

To have healthy children, parents should be free from disease, 
either inherited or acquired ; should exercise no deleterious 



THE CHILD — ITS DISEASES. 725 

trade, nor should they use alcohol or tobacco — both productive 
of imbecility and nervous disease in the child — and should 
have healthy organizations, and conform to all the require- 
ments of hygiene. 

A most important condition to our having healthy children, 
is to give them abundance of pure air to breathe. Respiration 
is the first act of independent life ; air is a vital necessity. Shut 
a child up in a close room, or in a crowded city, every breath 
he takes changes the quality of the atmosphere ; it loses oxygen, 
becomes loaded with carbonic acid gas ; besides, there are the 
emanations from skin and lungs, which are poisonous. Pure air 
is essential to life, to the blood, and to all the tissues. 

Next to air comes exercise ; the activity of every organ and 
function. There is not an organ, muscle, faculty, gland, but 
what was made for use, for movement, exercise. Exercise is 
necessary to development; without it, anaemia and disease. 
Good health requires, nay, demands, the regular performance 
of all the organic and animal functions, secretions, excretions, 
and all muscular, nervous, intellectual, moral, and passional 
activities. It demands for the entire body, bathing once or twice 
a day ; it demands a temperature neither too warm nor too cold, 
and easy clothing, so as not to impede motion, aeration, and 
perspiration. As destruction is rapid, and renewal very active, 
everything about a child should be scrupulously clean. 

Rest and sleep are important factors in growth. Sleep, during 
which the brain picks up its pabulum from the blood ; the brain 
must rest for fresh supplies. The child, the microcosm of Deity, 
with its dawning intelligence, sleeps nearly all the time. Nothing 
so withers and blasts incipient vitality as want of sleep. In 
childhood, ten to twelve hours in the twenty-four should be 
devoted to sleep ; in maturity, eight hours is sufficient ; and in 
%»old age, we do with less. 

Management of the Infant at Birth. — The most striking 
picture of utter helplessness that can be imagined is that of 
an infant at birth ; for if assistance be not speedily afforded it 
will perish. The first thing to be attended to is the umbilical 
cord, which should be tied with saddler's silk, about three- 
fourths or one inch from the abdomen ; then another ligature 
about an inch further on, and the cord divided between the 
two with clean- cutting scissors. Any mucus should be removed 
from the mouth, or ears, and it should be examined to see that 
it is a perfect child. After the function of respiration is estab- 
lished, the infant should be wrapped up in a blanket and kept 
very warm, protected from cold, and the nurse, or other attend- 
ant, should bathe it at the earliest opportunity, after the mother 
has been duly cared for. The first bathing of the infant is of 
much importance, and it should be performed with the greatest 



726 THE CHILD — ITS DISEASES. 

care and precision. All children, to a greater or less extent, are 
covered, either partially or wholly, with a thin or thick seba- 
ceous secretion, which will not unite with soap, but readily 
unites with fat or oil. So, after the nurse has been provided with 
a low stool, a basin of tepid water, castile soap, and some olive 
oil, or lard deprived of its salt, she sits down and first freely 
anoints the scalp of the little stranger, rubbing it in gently, 
efficiently, causing it to unite with the sebaceous secretion, 
and then takes the soap and washes off; then she goes over the 
face, ears, and in the same manner, being most careful that not 
a particle of this matter enters the eye, ear, vagina, axillae, as it 
causes inflammation ; and being very careful that not a particle 
of it remains about an ear-lobe, angle of nose, a fold or crevice 
of the skin. Then she manipulates each arm in the same man- 
ner, washing the arms, and watching the armpits and fingers, 
then the limbs, and looking after the corrugations about anus, 
folds of vagina, groin. The utmost care should be exercised, and 
if it has been heavily covered, it might not hurt to bathe it in 
the same manner again in a few hours, lest the smallest particle 
or patch may have escaped observation. The perfect removal 
of this sebaceous secretion is all-important, and should receive 
the most careful attention and scrutiny, so as to prevent oph- 
thalmia and other inflammations 

After the child is thus not only bathed but thoroughly cleansed 
and well dried, a double piece of fine old linen, four inches square, 
with a hole in the centre to permit the passage of the cord, 
slightly scortched, should be applied over the navel, bringing 
the cord through the orifice, and the linen laid flat on the belly. 
Then another piece of linen the same size, with a hole in centre, 
should be applied, into which the end of the cord should be 
wrapped up and turned over to the right side ; and over and 
above all, a roller or bandage of finest flannel, reaching from 
the breasts to the groin, should be evenly and neatly pinned ; 
and then the general clothing of the child, which should be 
easy and warm — flannel or silk. If the mother has been prop- 
erly cared for, and the labor not too exhausting, she will have 
milk ; and it is the best plan to put the child to the breast 
pretty soon, as the mother's milk is the true nourishment for 
the infant, that which nature has provided, a perfect combina- 
tion for the due elaboration of every tissue in the body. Still, 
there are cases in which this cannot be done, and the child 
must be nourished with a little milk and water, or sugar and 
water. We are, however, most partial to mother's milk, as it 
cleanses out the bowels of the meconium, gives the nipple a 
better shape, facilitates a better flow of milk, induces contrac- 
tions of the uterus by its reflex action, and diminishes all risk 
of secondary haemorrhage. 



THE CHILD — ITS DISEASES. 727 

The child, for the first fifteen months, should be bathed morn- 
ing and night — a thorough ablution — followed by gentle fric- 
tion, and clean, soft clothing, to maintain an active condition 
of the skin. Tepid bathing for infants is always to be preferred. 
Very great cleanliness should be observed, diapers changed the 
moment they are damp, soiled, and moistened parts sponged off. 

About the fourth month a child should have sufficient exer- 
cise in the open air, be occasionally placed in a sitting posture, 
and be allowed to roll round and kick at its pleasure. All these 
movements not only afford amusement, but act beneficially, by 
calling the different muscles of the body into action, and so 
increase their strength. A child should be exercised during 
the day, so that it may enjoy undisturbed repose at night. 

The child should be weaned between twelve and fifteen 
months, provided it has teeth, and the season of the year war- 
rants. No child should be weaned at the approach of summer, 
not unless the mother be pregnant, then it should not be kept 
an hour at the breast, irrespective of season or age. In wean- 
ing, it should be gradual, less and less daily, gradually substi- 
tuting milk-food and ordinary solid nourishment. In all cases 
avoid starchy food, as rice, arrowroot, corn-starch, farinas, as 
they contain neither brain nor bone — not food for a Caucasian 
child ; besides, the child has no saliva to digest starch. In 
order to be brief, we shall next direct attention to various pecu- 
liarities of the infant, and then to special diseases. 

Peculiarities of the Infant. — Infancy may be said to ex- 
tend from birth to the second year, or completion of dentition ; 
and childhood to the age of puberty. The general appearance 
of a new-born infant is as follows : It usually measures twenty 
inches, more or less, and weighs about six or seven pounds, 
more or less. The skin is very vascular, sensitive, and deli- 
cate ; of a deep red color. All the prominent parts of the body 
are well protected by fat and cellular tissue ; the tendons and 
ligaments are imperfect ; the muscles soft and gelatinous ; the 
bones are small, chiefly cartilaginous, deficient in earthy matter; 
the lower extremities are less developed than the upper ; the 
pelvis is small and looks contracted ; the thorax small, flattened 
at the sides, prominent in front ; the head and abdomen large. 

The digestive organs are perfectly adapted for producing 
rapid changes in the food introduced into them ; indeed, they 
afford room for a continual supply of the materials for nour- 
ishment and growth. The mouth is beautifully adapted for 
extracting the food prepared by the mother, and conveying it to 
the pharynx. The stomach is small and long, which shows 
that it is not suited for receiving much food at a time, or for 
retaining it long. The intestines are smaller and shorter than 
in the adult ; their peristaltic action is rapid, so that all excre- 



728 THE CHILD — ITS DISEASES. 

mentitious matters are quickly got rid of, the infant having an 
evacuation every four or five hours. The mucous membrane 
of the whole alimentary tract is thick, soft, villous, very vas- 
cular, and sensitive, and easily irritated by improper food ; the 
salivary glands, the pancreas, the lacteal vessels, the mesen- 
teric glands, are largely developed ; the kidneys are large, the 
suprarenal capsules of considerable size ; the spleen is small, 
liver very large, occupying one-third of the abdominal cavity, 
but becomes smaller by changes that take place in its circula- 
tion. The respiratory organs undergo a great change; the 
lungs, on being permeated with air, increase in size, become 
light, vesicular instructure, and of a deep rose red ; the respira- 
tions are nearly double those of an adult. The action of 
the heart is quick, varying from 120 to 130 beats in a minute. 
In looking at the nervous system, we find the brain large, soft, 
imperfect in structure, and weighing about ten ounces; the 
convolutions are imperfectly marked ; intelligence is in direct 
proportion to their extent, while the gray portion scarcely dif- 
fers from the white, in color. The meninges are more vascu- 
lar than in the adult. The structure of the spinal cord and 
nerves is more perfect than that of the brain ; those parts being 
devoted to functions of sensation and voluntary motion. The 
organs of the external senses are all present at birth, and the 
nerves distributed to them are large. 

Peculiarities of Diseases in Children. — During childhood 
little boys are very delicate, and susceptible to disease, whereas 
little girls are tough and wiry, and resist morbid action. After 
puberty, the young man is the vigorous, and the young lady 
the delicate, or tender, thus reversing the conditions. In child- 
hood, in both sexes, there is a predisposition to disease on ac- 
count of inherent weakness of organization, and the ease with 
which impressions are made, and disease at that period of life 
is very apt to be insidious, and run a very rapid course into 
some organic change. The activity of the vital force, the 
quick metamorphosis of tissue, predisposes to inflammatory 
disorders, and the great susceptibility of the nervous system to 
impressions causes any affection to be keenly felt by the whole 
system. Hence, the slightest disease, or indisposition in a child 
should never be regarded with indifference. It is also true 
that the same activity of the vascular and nervous system im- 
parts an energetic, reparative power in the child, and essen- 
tially aids recoverv from some severe affections which would be 
fatal in advanced life. 

The skin the and mucous membrane of the respiratory and 
digestive organs, are the principal points upon which morbid 
impressions exhibit themselves, although they originate in the 
stomach, or from outside influences. The mucous membrane 



THE CHILD ITS DISEASES. 729 

of the larynx, trachea, bronchial tubes, is liable to inflamma- 
tion of various grades, mostly of an acute character. The gastro- 
intestinal mucous membrane is another source of disease in 
early life, and owing to irritation of these parts, so abun- 
dantly supplied with the sympathetic nerve, and the increased 
sensibility of the reflex centres in modern children, give rise 
to innumerable brain affections. Hence, the frequency of fits, 
convulsions, and cerebral disease. The early growth of the 
lymph canals, or lymphatics, render them obnoxious to morbid 
action. Diseases of the urinary organs are not frequent nor 
severe. 

The diseases of children present many interesting and re- 
markable features, the peculiarities decreasing as age advances. 
All affections of children, even the process of dentition, are 
attended with fever of a remittent type, having exacerbations 
towards evening or during the night, 

In all cases of disease in the infant the causes are the same 
as at other periods of life, though they react upon the child with 
greater severity than the adult. Errors in diet, impure air, 
inattention to the laws of health, intense cold, heat, damp, filth, 
meagre or improper food, insufficient clothing, disease-germs, 
poison ; reflex states, as dentition, worms, accidents, act ener- 
getically upon its feeble constitution. Again, many disorders 
that exist in early life may not exist at birth: Thus, some are 
unfortunately born with the germs of syphilis, tubercle, in their 
blood. The chief causes of death among our children are 
cholera-infantum; disease of the brain, superinduced by indi- 
gestion ; acidity, worms, teething, bad food, and the like. 

Diagnosis of Infantile Diseases. — A little good sense is 
all that is necessary to form a correct diagnosis of the diseases 
of the child. The chief sources from which our information is 
derived are the countenance, the gestures, attitude, the sleep, 
the cry, the mouth and breath, the respiration, circulation, etc. 

Countenance. — The human face divine is the most interest- 
ing and intelligible page in the book of nature. In its calm 
and smile, we read health, ease, happiness of mind and body ; 
in pain and suffering we discover disease. 

In general uneasiness, excitement, and fever, the whole 
expression of the countenance is altered, a flushed and wrinkled 
condition alternately being remarkable. 

In affections of the brain and nervous system, the expression 
of the upper portion of the face, as the forehead, brows, and 
eyes, is especially changed ; the skin white, the forehead con- 
tracted and heavy ; the brows are knit ; the eyes wild and 
vacant, or fixed and staring, partially open ; rolling of head ; 
squinting; dropping of eyelids. 

Morbid conditions of the organs of respiration and circulation 



730 THE CHILD — ITS DISEASES. 

affect the features of the middle of the face : the nostrils, in 
pneumonia, are dilated ; the tip of cheeks red ; sharp, dark cir- 
cle round the mouth. In cardiac irritation, features are con- 
tracted. 

In diseases of the abdomen, a peculiar expression is given to 
the face : cheeks sallow, sunken ; the mouth retracted or drawn ; 
the lips colorless. In irritation of the bowels from worms, the 
nose and upper lip are tumid, a dark ring below the eyes and 
round the mouth, and the white of the eye has a pearl-like 
look. In the exhaustion from diarrhoea, the face is alternately 
flushed and pale, hot and cold ; in extreme cases, pallid, cold, 
glistening; the eyelids half closed. In jaundice, the counte- 
nance is yellow. In measles, the running from eyes and nose, 
redness of the eye, swelling of eyelids, never can be mistaken. 
The features are emaciated, and present an appearance of de- 
crepitude, in tabes mesenterica. The peculiar feverish look, 
sharp features, sunken eyes, pallor, of cerebro-spinal irritation, 
never can be mistaken. Pain in the head causes the brows to 
contract ; in the belly, the upper lip is elevated ; in the chest, 
sharpness of nostrils. Before convulsions come on, the face 
becomes convulsive, the upper lip is drawn, there is squinting. 
Suffusion of the face denotes fever ; flushes of heat and coldness 
denote exhaustion. 

Gestures and Attitude. — The beginning of disease in a child 
is made apparent by inattention to surrounding objects, by 
their listlessness, and dislike to movement. They then be- 
come restless, languid. Inflammatory pain may make a child 
still. In abdominal inflammation the child lies quiet; the 
knees bent, drawn up ; twisting about ; uttering loud cries 
on the sudden accession of pain. Acute spasmodic pain induces 
immediate contraction of all the muscles, and the infant 
starts in terror. In convulsions, the head is thrown back, an 
arm becomes rigid, or a leg is drawn upwards, and the child 
cries violently from pain or fear; the breathing is spasmodi- 
cally affected ; the thumbs and fingers are drawn into the palms 
of the hands ; the toes are firmly flexed downwards. In irri- 
tation of the brain, the little hand is frequently raised to the 
head, attempts made to tear off its cap, and perform other move- 
ments with the hands, while the head is rolled from side to side 
on its pillow. In disorders of the mouth, as difficult teething, 
the child presses its fingers into the mouth, or seizes and presses 
the nipple roughly and greedily, or rubs the gums with any- 
thing it can get hold of. In croup and other diseases producing 
difficulty of breathing, it pulls or grasps at the larynx, and tries 
to compress it laterally, and by its cries indicates the seat of 
suffering, which is relieved by the sitting posture. During 



THE CHILD — ITS DISEASES. 761 

dentition, throwing back the head, grinding of the jaws, or 
irritation of digestive tract, indicates convulsions. 

The Sleep. — The sleep of a healthy child is deep, tranquil, 
prolonged ; the countenance is calm and happy ; the breathing 
slow and easy ; its limbs relaxed ; on awakening, it is lively, 
and seeks the breast. In disease, the rest is disturbed, broken ; 
the respiration is loud, labored ; the brow contracted, or the 
mouth drawn ; there is grinding of the teeth, or gums; sudden 
startings ; the child is fretful, irritable, peevish. Any irritation 
anywhere, but especially in the brain or bowels, lessens the 
ability to rest. Rigid extension of the limbs, with a turning-in 
of the great toes and thumbs, is indicative of convulsive move- 
ments. In jaundice, there may be deep sleep or coma. 

The Qry — The first indication that a new-born infant gives 
of life is to cry, and the more loudly and lustily it does so, 
the better, as it thereby inflates the lungs more perfectly, and 
demonstrates the fact that the vital organs are well and vigor- 
ously formed, and the child in good health. But after being 
bathed, clothed, and warmed, and otherwise seen to, the well- 
cared for infant cries but little ; the act of crying being reserved 
to express pain, distress, hunger. Pain is productive of crying. 
In affections of the lungs, the cry is more of a groan ; in croup, 
hoarse, muffled, crowing; in cerebral disease, screams, with 
great irritability at intervals ; in diseases of the abdomen, the 
cry is prolonged, low, moaning. The sympathetic nerve and 
lachrymal gland being rudimentary until three or four months ; 
the little sufferer does not shed tears in crying until after that 
period. After fourth months, if a child shed tears in the act of 
crying, it is a most favorable sign ; but if the eyes are dry, sunk 
in the orbit, great danger to life exists. 

The Mouth and Breath. — In health, the mouth is moist and 
pale, the tongue smooth, and partially covered with a layer of 
whitish mucus; the gums red, the breath sweet, free from smell 
or odor, only that of the mother's milk. This is altered by very 
slight causes ; the mouth may become hot, dry, red ; the tongue 
coated, and the mouth sour, acrid. This is the case in fevers, 
acute affections of the chest and abdomen, and in retarded, 
difficult dentition. In the eruptive fevers, tongue often swells, 
or its papillae projects. In scarlet fever, with its strawberry 
papillae, it sometimes presents a swollen, hot condition. In sore 
mouth, or aphthae, due to bad milk, indigestion, teething, over- 
crowding, the breath is fetid, tongue excoriated, and there may 
be ulceration on various parts. See Aphthae. 

The Skin and Temperature. — In a healthy skin of an infant 
we should find it firm, elastic, smooth, of a rosy flesh-color, 
neither hot nor pale, but moist and cool. A hot skin is pres- 
ent in all febrile diseases; a cold, moist skin in feebleness 



732 THE CHILD — ITS DISEASES. 

and prostration. Great redness indicates inflammation, or the 
eruptive fevers ; a pale, doughy skin warns us against tuber- 
culse ; intense blueness, to cyanosis, a mixture of the arterial 
and venous blood, or some interference with the oxygenation 
of the blood ; a yellow skin, to some affection of the liver ; a 
dirty, sallow hue, to diarrhoea. Rigors are not common in 
young children, even suffering from malarial fever, the usual 
symptoms being a paleness of the face, a discoloration of the 
lips, a bluish tint beneath the nails. 

Respiration — An infant breathes instinctively, without 
method, but with regularity. All diseases of the air-passages 
are attended with noisy, rattling respiration and cough, which 
is hoarse and spasmodic in inflammation of the glottis ; ringing 
in laryngitis ; crowing in croup. In catarrh, bronchitis, pleuris} 7 , 
and pneumonia, the breathing is merely hurried, the cough 
hacking and dry, and the expectoration, as it comes up, is 
swallowed by the child. As the inflammation increases, the 
rapidity of the breathing becomes great, so that in lung con- 
gestion it is often panting; at the same time there is rapid dila- 
tion and contraction of the nostrils. In pleurisy, the respira- 
tion is restrained; in peritonitis, the inspirations are short, 
jerking, difficult. 

The Circulation. — The heart's action is more variable in 
infancy than any other period, and impressions of every kind 
quicken the pulsations. Pulse, in health, ranging about 130. 

Discharges by Vomiting and Stool. — The first stools after birth 
are of a black, or dark-green color, called the meconium. 
Subsequently they become brown, or of a yellow hue, of a 
curdy consistence. The bowels move frequently in health — about 
every four hours. Heated milk, or anything that disturbs the 
digestive organs, may cause vomiting and diarrhoea, and reflexly 
act on the brain. A great many diseases of childhood are 
ushered in by vomiting, or diarrhoea, as cholera infantum, 
whooping cough ; and the expectoration swallowed in diseases 
of the chest is often vomited, or causes diarrhoea. Frothy, acid, 
stools, with undigested milk, indicate disorder of the stomach 
and pancreas ; green, or chop spinach stools, irritation of liver 
and brain ; slimy stools, common in difficult dentition, or when 
worms are present in bowels ; thin, fetid, dark-brown stools 
indicate chronic diarrhoea. Constipation is rare among children 
when they are fed on milk diet, until teeth are present for mas- 
tication. 

The Urine. — Scanty and high-colored in all fevers and in- 
flammations ; of an intense uriniferous odor in difficult denti- 
tion and marasmus ; scanty, almost suppressed, in disease of 
the brain; complete suppression may follow a fall, shock, jar; 
in disordered liver, stains diaper a deep orange color. 



THE CHILD — ITS DISEASES. 733 

DISEASES OF INFANTS. 

It will be impossible to notice the disease, accidents, deform- 
ities, nutrition, dentition, of infants, in anything like order, so 
we shall isolate them and enumerate singly. 

Inflammation of the Umbilicus. — Many ignorant medical 
attendants, self-conceited nurses, and meddling old women, in- 
sist upon various applications to the navel, especially rancid 
and trichinous lard, which softens, irritates, and causes ulcera- 
tion at this point. The scorched linen rag, which we have re- 
commended, is the best application : it is absorbent and anti- 
septic, and always procurable. The period of time that elapses 
before the cord separates, is about the fourth day, and in cold 
weather, perhaps five or six. When it has not been tampered 
with, a slight oozing of serum takes place, and the part heals ; 
but owing to some condition of irritation, that instead of heal- 
ing, it may become inflamed and ulcerated ; suppuration takes 
place, and very serious hsemmorrhage may occur. When this 
takes place resort at once to antiseptic washes, for in the ulcer the 
oidium albicans are abundant, and must be immediately de- 
stroyed. So bathe it with the borax or permanganate of potass 
lotion weakened down to suit age, and then dress with vaseline 
or ozone ointment. 

Swelling, or Milk in the Breasts. — The breasts of the infant 
often swell after birth, and become engorged with serum and 
milk. The best plan is to open the bowels freely with oil ; give 
a little sweet spirits of nitre, and apply over the breasts a lotion 
of muriate of ammonia, and if it does not disappear quickly, 
belladonna in tincture form, or put on the iodide of potass, 
muriate of ammonia, and belladonna ointment. If still stub- 
born, iodide of potass, in grain doses, internally, thrice daily. 

Retention of the Meconium. — The black, or dark -green, 
viscid matter known by the name of meconium, is sometimes 
retained in the bowels after birth, instead of being discharged 
freely the first day or so. Its evacuation is promoted by the 
first milk secreted by the mother, which is of a slightly aperi- 
ent nature. 

As a rule, this is sufficient to bring away the meconium, but 
if it does not then it should be aided by medicine; a little 
castor-oil might be tried ; that not proving satisfactory, a few 
drops of fluid extract of leptandra in water, in which one or 
two grains of bicarbonate of potassa has been dissolved. 

The Yellow Gum. — If the meconium is not discharged 
promptly, its presence seems to give rise to irritation and obstruc- 
tion of the biliary ducts, forcing the bile back into the liver ; 
the meconium becomes impacted in the intestines, and a con- 
dition of jaundice supervenes; or the jaundice may be due to 



734 THE CHILD — ITS DISEASES. 

the disturbance of the hepatic circulation, on the transfer of its 
chief blood-supply from the umbilical vein ; or, owing to some 
condition of congestion, there may be difficulty in the bile find- 
ing its way into the duodenum. 

This causes languor, indolence, yellow skin, bilious urine, a 
tendency to deep sleep, which keeps child from nursing, and 
may prove fatal. In some cases it assumes the condition of 
true jaundice. 

Treatment, — Cleanse out the bowels with oil ; follow with a 
solution of phosphate of soda, one grain every two hours. A 
few drops of the fluid extract of leptandra, in the neutralizing 
mixture, should be given morning and night. If liver does not 
act very promptly, better to put one grain of calomel on the 
tongue, follow with the breast, and in an hour with a teaspoon- 
ful of oil. This may be repeated and followed with bicarbonate 
of potassa in a little water, the idea being to rouse up the liver, 
free the gall-duct from all viscid secretion. 

Asphyxia, or Still-Born. — The apparent or real cessation 
of life in a new-born infant may be due to a variety of causes, 
such as inherent weakness of the vital powers ; peculiar con- 
formations; collections of glairy matter in the bronchi and 
air -vesicles of the lung; the introduction of a quantity of 
amnii into the trachea, and congestion of the lungs, arising 
either from the neck of the child having been tightly encircled 
by the os uteri, or vulva, or navel string ; or from its being 
long detained in the passage, from pressure of the cord in 
breech presentation, or where the cord is prolapsed, or where 
the mother has been dosed with ergot. From the exhibition 
of this latter during labor, we have asphyxia, or still-born 
of a peculiar kind : the blood is coagulated in brain, heart; the 
child bloodless, and rarely manifests a sign of life ; its blood 
dried up, mummified ; and no method of reanimation can 
restore it to life. When unusual weakness of vital power seems 
to be the cause, and there are active pulsations in the cord, lay 
the child on right side, keep it warm, rub it gently ; but do not 
slap it on either the back or side, and do not ligate the cord as 
long as pulsations are good ; artificial respiration should be 
tried ; but blowing in the nose, and trying to inflate the lungs 
are very unsatisfactory, as the air is frequently blown down 
into the stomach as well as the lungs. If pulsations have ceased, 
ligate cord at once, and try the usual means for suspended 
animation. Then cleanse thoroughly ; wrap in flannel ; rub 
gently; use tincture of capsicum down the spine; sprinkle 
alternately hot and cold water on the chest, so as to get it to 
sigh, and thereby inflate the lungs; blow on face. Try arti- 
ficial respiration, warm bath ; and be careful while pursuing 
these or all those means, that the child does not lose its heat ; 



THE CHILD — ITS DISEASES. 735 

keep it in flannel, and rub with tincture of capsicum and whis- 
key. If there is an electro-galvanic machine about, set it at 
work, applying the positive pole to spine, negative over stomach 
and diaphragm. This is often effectual. If respiration can be 
established, give a few drops of brandy in sweetened water, and 
repeat at intervals. 

When a portion of the liquor amnii gets into the trachea, 
and produces asprryxia, or the mouth of the infant is discovered 
to be filled with a glairy matter, rendering the respiration diffi- 
cult, sonorous, rattling, we must wash out the mouth and throat ; 
place child over on its belly on the nurse's lap, which will 
facilitate the discharge of the liquor. Having done that, we 
must endeavor to reanimate the child in the usual manner. 

If a congestion of the lungs be the cause, or if you suspect 
the nurse or physician has been dosing the mother with forcing- 
powders (ergot), then it is a good plan to untie the cord, and let 
from a teaspoonful to a tablespoonful or more of blood escape ; 
then follow with warm mustard-bath, friction to surface. Slap- 
ping the infant is always reprehensible, as its lungs, liver, 
spleen, kidneys, and other organs, are so soft that they are lia- 
ble to lacerate. In all cases adhere to the rules laid down for 
Suspended Animation. 

Medical men are often called upon to give evidence in cases 
of supposed infanticide ; it seems proper to mention that much 
careful observation and experience is required to discriminate 
between a child that is still-born, and one that has lived only a 
short time after its birth. Various appearances, both internal 
and external, may be mistaken for marks of violence. Even 
the floating of the lungs in water, a test on which much re- 
liance is placed, is found on many occasions to be fallacious ; 
for they will float if a putrefactive process has commenced, as 
well as when filled with air by respiration. It may also hap- 
pen that an unmarried woman, on arriving at the full period, 
and having concealed her condition, may be taken ill alone 
and be delivered of a live child ; but that either from syncope 
ensuing speedily, or from a convulsion, or from loss of reason, 
or a distracted state of mind, or some other cause, that she may 
be so far overcome as to be rendered incapable of assisting her- 
self or child, and it may have been suffocated by the bedclothes. 
In other instances it may happen that the child is born alive, 
still, from some injury in the birth, or inherent weakness, or 
some other obscure cause, it may cease to breathe without receiv- 
ing any injury from the mother. No doubt cases of this nature 
are of daily occurrence, and they point out the impropriety of 
placing any reliance on the floating of the lungs in water as a 
test of infanticide. 

The dictates of humanity and reason require a radical change 



736 THE CHILD — ITS DISEASES. 

of this method of evidence, as it has been often injudiciously 
used. 

Excoriations, Chafing, Ulcerations. — From a want of care, 
neglect of proper cleanliness, children are very liable to chafe, 
or excoriate, in the folds of the neck, behind the ears, in the 
groin, and around the arms. To prevent this, there should be 
a removal of all damp or soiled linen promptly, the parts dried 
and exposed to the air. It is a good plan to bathe all excori- 
ated parts with warm milk and water twice or thrice daily, or 
an infusion of sage tea and borax, and afterwards dust with 
pulverized starch, or rub over with vaseline. If the excori- 
ations are of considerable extent and depth, use a solution of 
borax for a wash, and apply the ozone ointment for a dressing; 
this will heal them rapidly. In obviating excoriations, it 
should be our aim to prevent the secretions of the body from 
mingling with them. 

In tubercular children, about the time of teething, when the 
child suffers from malnutrition, bacteria are very abundant in 
alimentary canal, blood, and they find their way about the skin 
of the ears and other parts, which gives rise to sores, the secre- 
tions from which are highly contagious. In these cases, an 
effort must be made to correct the malassimiiation, by sulphate 
of cinchona and elixir cinchona. The sores should be bathed 
with a decoction of poppies, and either kept dry by dusting on 
pulverized storch, or applying ozone ointment. 

If the case is stubborn, push better food; pure air; and alter- 
atives, as iodide of potass ; and use stronger antiseptic washes 
locally. 

Non-expansion of the Air-cells of the Lungs, — It often 
happens from a weakness, or from a long, tedious labor, or from 
severe compression of the head, or from the little one's blood 
being coagulated by ergot administered to the mother, that it 
is unable to inflate its lungs perfectly ; that there is a non- 
expansion of the air-cells, and the infant looks as if about to 
die. It soon becomes jaundiced ; cry consists of a mere whim- 
per; inability to nurse; drowsiness, exhaustion, are great; sur- 
face cold and livid ; chest but partially dilated by imperfect 
respiratory movements; the lung condensed, but the consoli- 
dation will give way as strength is gained ; and good health 
may be attained, or death may occur from exhaustion and 
convulsions. To prevent this, bathe the child, wrap up in 
warm flannel in a room 80° F. ; hot bath twice every twenty- 
four hours; massage gently with sweet olive oil, especially about 
the chest and abdomen ; nourish every two hours with juice of 
raw beef, or milk and lime-water ; open bowels with magnesia. 

Cephalsematoma. — If the labor has been long, tedious, or 
the head large and pelvis small, or the presentation a difficult 



THE CHILD ITS DISEASES. 737 

one, it is very apt to so compress, or stagnate, or rupture vessels 
on the scalp so as to cause the formation of a bloody tumor after 
birth between the bones of the skull and pericranium. Long- 
continued pressure is the cause. 

Symptoms. — Tumor varies in size from a hen's egg to that 
of a large orange. It is generally formed on one of the parietal 
bones; on right more frequently than left, and occasionally on 
both. Swelling is soft, fluctuating, and circumscribed ; its base 
often becomes encircled with a hard ring, caused by the coagu- 
lation of the plasma exudation. 

Treatment. — Never incise, nor apply compression ; admin- 
ister a gentle purge, and apply a solution of muriate of ammo- 
nia, not very strong. If anxious regarding it, a solution of 
iodide of potass, five grains to the ounce, of lime-water, and 
apply 

Convulsions of Infancy. — There is a very rare form of 
convulsions occasionally met with in infants, which is epileptic 
in its character, and leads to impairment of the intellectual 
faculties. 

It consists in a peculiar, involuntary, rapid bowing forward 
of the head, and in some cases the whole body. The bowings 
are repeated in quick succession, one following the other, occur- 
ring every day, or less frequent ; usually worse in the morning, 
or when awaking from sleep. After child grows old, regular 
epileptic attacks take their place; pure epilepsy, or convulsions, 
or paralysis, and wasting may follow. By attention to bowels, 
skin, and administration of alteratives, the S3 T mptoms will sub- 
side, and the health be completely restored. 

Treatment same as for Epilepsy and Convulsions. 

Nine-day Fits. — There is a peculiar form of tetanus, or lock- 
jaw, that occurs in infants about second week after birth, and 
is very fatal. It is supposed by some to be due to cutting the 
navel-string or cord with blunt scissors, or to the application 
of irritating agents about the navel. 

Others imagine it to be due to cold, foul air, improper feeding, 
imperfect bathing, retention of the meconium, ergot to mother. 
Precautions ought to be taken in the dividing of the cord that 
it be done by clean-cutting scissors ; that no irritants be applied 
to navel ; that the child be properly seen to by proper bathing, 
pure air, cleansing out its bowels with oil. 

As a rule, it is fatal. 

Imperforate Anus. — A congenital defect, often overlooked 
at the bathing and dressing of the child. It signifies a closure 
of the rectum, and may occur in various degrees. The anal 
opening may be closed by a thin, fine skin, which soon becomes 
distended with meconium ; or the bowel may terminate in a 
blind pouch at any point from the sigmoid flexure downwards, 

59 



738 THE CHILD — ITS DISEASES. 

and the anal aperture be altogether wanting ; or the anus may 
be open for an inch or two, with an obstruction beyond ; or the 
rectum may terminate in the bladder or urethra. 

Treatment. — If the end of the intestine can be felt pro- 
truding when the child cries, make a free crucial incision into 
it without delay ; if it cannot be felt, an incision of the same 
kind made, and the parts explored, and an effort made to reach 
the bowel, which, if reached, is to be pulled down and opened. 
Nature is very provident in those cases. Give her an opening, 
and she rapidly forms around the descending meconium a wall 
or tube, which becomes a rectum. The opening at anus should 
be large enough to admit the finger — always made crucial. It 
is recommended, if no bowel can be tapped per anus, to make 
an artificial opening, or anus, in left groin. 

Hide-Bound ; or. Sclerema. — A peculiar disease of new- 
born infants, consisting of an induration of the skin and sub- 
cutaneous tissue, with serous effusion, occurring at birth, or 
within ten days subsequently. It seems to depend on the lat- 
ent elements of syphilis. 

Symptoms. — The skin, at first, is dry, stiff, withered ; then 
assumes a waxy, yellowish appearance, and gradually becomes 
distended and unyielding ; so the babe is said to be skin-bound. 
It grows cold, prostrated, unhealthy, and often jaundiced. In- 
dications of distress in the restless, whining cries ; refuses the 
breast; feeble pulse and laborious respiration. Gastric, and 
intestinal disturbance sets in, and death is ushered in with 
prostration and asphyxia. 

Treatment. — Use warm bath ; inunction of oil ; flannel ; solu- 
tion of raw beef, and one grain doses of iodide of potass ; milk 
and lime-water ; keep bowels open with neutralizing mixture, 
and see that kidneys act well. Death is almost inevitable. 

Hiccoughs. — Some infants are greatly incommoded by hic- 
coughs. They usually arise from some acidity of the stomach, 
or from some nervous irritation. 

If due to acidity, try a few drops of lime-water in milk ; a 
grain of bicarbonate of potassa, in milk, or the neutralizing 
mixture. 

If due to nervous irritation, try one drop of chloroform, in 
water, sweetened, or tincture of aconite, or belladonna ; or a few 
drops of aromatic spirits of ammonia in water ; or some aro- 
matic tea, as catnip, anise seed, carraway. In some cases a few 
drops of vinegar proves very effectual. If persistent, and not 
relieved, then some stimulant to spine and over stomach, as 
soap liniment and lobelia. 

Our Infantile Mortality. — Our country, noted for every 
practical improvement, every species of philanthropy, every- 
thing capable of ameliorating human toil and suffering, suffers 



THE CHILD — ITS DISEASES. 739 

the greatest infantile mortality in the world. Much of this is 
due to solar heat, city life, insanitary conditions, special dis- 
eases, but the greatest causes are bad feeding and improper 
drugging. The practice of not nursing, or weaning early, is 
now becoming more common, as the struggle for existence be- 
comes greater, so as to enable the mother to work. As a result, 
the babe is fed on starch, farina, corn-flour, boiled bread, sour, 
or swill milk ; articles it cannot digest ; so that it starves — takes 
marasmus; because it has lost the main factor of nutrition, 
mother's milk, it sickens, dwindles and dies. Parents cannot 
be too frequently informed of the unsuitability of farinaceous 
food to children. The practice of an American mother in this 
land of freedom and wealth, being compelled to work during 
pregnancy and nursing, drains away the life and vigor of both 
mother and child. It makes the mother prematurely old, and 
stunts the growth and destroys the vitality of the child. A 
mother's labor, a mother's worry and strain should be mini- 
mized by every possible means, and work avoided. 

As for drugging babes, it is a great wrong, and the immediate 
and remote cause of much mortality. Think of the millions of 
bottles of soothing syrups that are annually consumed, all loaded 
with opium, which whittles down and mummifies our new 
growth. Introduce a better system of feeding : milk-food free 
from starch ; abolish drugging, and we will save this element 
of national greatness that is now lost. 

Infantile Syphilis. — Parents, either father or mother, affected 
with the syphilitic germ, are liable to transmit it to their off- 
spring. In the case of a father affected, and the mother free 
from the disease, the healthy uterus of the mother is likely to 
repel the diseased foetus at four or seven months, and cause an 
abortion ; but in some cases the mother may carry her preg- 
nancy through, and the child may be born, apparently free from 
disease. But in a period of time, usually inside of six weeks 
after birth, the original pock of the father will appear on the 
skin of the child in the shape of blisters about ears, nose, face, 
body, arms and legs, forming a regular rash, copper-colored. 
Very soon there is a general shrinkage, or shrivelling of the 
skin, with general s} T philitic ulceration of mouth and throat, 
and other parts. In othes cases, the infant may be born with 
the withering effects of syphilis visible over its entire bod} 7 ; 
its hair may drop off, and general ulceration may occur. 

In still another class of cases, there may be no visible appear- 
ance on skin, but the disease may exhibit itself in the bones in 
a separation of the growing extremities of the ends of the long 
bones, which leads to the separation of their epiphysis. 

This affection of the growing bones seems to be painless, and 
even more amenable to treatment than the skin eruption. 



740 THE CHILD — ITS DISEASES. 

Same treatment as for Adult Syphilis. 

Physicians meeting those cases in every-day practice, see the 
imperative need of legislative enactment to prevent the mar- 
riage of parties afflicted with this malady, entailing disease and 
death upon their offspring. Syphilis is a contagium vivum just 
as much as small-pox, and some gigantic effort is necessary to 
prevent its wide-spread dissemination. 

Teething, — Of all the occurrences to which children are 
liable, not one is attended with such grievous and distressing 
symptoms as difficult dentition. With regard to the time of 
their cutting their teeth, no fixed or exact period can be laid 
down; as in rare cases, some are born with teeth, others have 
them soon, others very late, and others extremely late. 

As a general rule, dentition commences, in the large majority 
of children, between the fourth and eighth month, and the 
process continues until the seventeenth month, and often later. 
The two front teeth of the lower jaw are those that usually 
appear first, and shortly after these are observed two more come 
out in the upper jaw, exactly opposite the two former. These 
are succeeded by the four molars, then the canine, and, last of 
all, those of an infant's first teeth, the eye-teeth, make their 
appearance, making sixteen in all. This is the ordinary num- 
ber of a child's first teeth, as they are called, but some infants 
cut four double teeth in each jaw instead of only two, making 
the number twenty. 

In children who are healthy and strong, who have a good 
mother and abundance of milk — a mother who eats a whole- 
some diet, with a daily meal of oatmeal porridge and cream, 
corn-bread, and boiled fish, the process of dentition goes on 
with perfect regularity, and the teeth are cut early, and without 
a particle of trouble or pain ; but in the unhealthy and weak 
infant, who has a mother reckless of her diet, the process of 
dentition is slow, tardy, uncertain, painful, and difficult. So 
that w T e meet with children cutting their teeth in a very irreg- 
ular way; perhaps the teeth appearing in the upper jaw at 
intervals apart, or overlapping, and the same in the under jaw, 
and various other conditions, which are attendant on tardy, 
difficult, or painful dentition. The first two teeth gives a 
pretty good index of what is to follow, the succeeding ones 
generally making their w T ay in a corresponding manner. This 
first set is called the milk-teeth, and are generally shed when 
the child becomes six or seven years old, according to their 
diet and health. 

At six or seven years of age, when the shedding begins, it is 
followed, in a gradual manner, by a fresh set ; and about the 
age of twenty-one they get one more in the corner of each jaw, 
which, from their appearance at that period of life, have been 



THE CHILD — ITS DISEASES. 741 

named their wisdom-teeth. The following table exhibits a fair 
average of the eruption of the teeth : 

Deciduous Teeth. 
(The lower generally precede the upper by two or three months.) 
Central incisors, . . . 5 to 8 months. 
Lateral " . . . . 7 to 10 
1st molars, . . . . 12 to 16 
Canines, . . . . 15 to 20 
2d molars, . . . . 20 to 36 

Permanent Teeth. 
1st molars, . . . . 5 to 6 years. 
Central incisors, . . . 6 to 8 " 
Lateral incisors, . . . 7 to 9 " 
1st bicuspids, . . . 9 to 10 " 
2d " . . .10 to 11 "■ 

Canines, . . . . 11 to 12 " 
2d molars, . . . . 12 to 14 " 
3d "... 17 to 21 " 

Difficult Dentition. — Premature decay of the teeth is in a 
great measure due to the want of vegetable phosphates in the 
mother's blood ; to her neglect of the daily use of oatmeal, corn- 
bread, and boiled fresh fish ; and the use of bakers' bread as 
diet. This also predisposes the mother to nervous diseases, 
w x hich correlate to the deterioration of the teeth, each influ- 
encing, and, in a measure, causing the other ; besides, the mod- 
ern system of over-stimulating the nervous system by early 
precocity, causing a defective process of assimilation and tissue- 
formation, especially in teeth. 

Symptoms. — Difficult teething exhibits itself in a variety of 
w T ays, but the great bulk of the symptoms are reflex — irritation 
transmitted to a weakened bulb and cord. The child becomes 
fretful, its skin wdiite ; nutrition is impaired; the gums swell, 
spread, become hot, tender ; the child is continually working 
with its mouth, desiring to bite something; irritable, restless, 
peevish ; some fever; increased heat in the head, or pallor, with 
dilatation of pupils ; there is often a hectic flush on cheeks, 
with eruption on the skin, especially on face and scalp ; a loose- 
ness of the bowels, with griping stools, of a green, pale, or leaden 
hue, sometimes mucus; and the child becomes very peevish; 
starts in its sleep ; eyes partially open ; rolls head, and throws 
its arms about, and seems convulsed in particular parts of the 
body. It exhibits great indications of brain-irritation : in some 
cases screaming, throwing head back, thrusting its fingers into 
mouth ; in other cases there is cough, difficulty of breathing, 
emaciation, marasmus, great fever, thirst, convulsions, and a 
bad train of symptoms. 



742 THE CHILD — ITS DISEASES. 

When the child is promptly cared for, its secretions and 
excretions kept natural, and elements supplied in its milk from 
which nature can make teeth, very few of the violent symptoms 
attendant on such a condition occur, and we need not appre- 
hend any bad symptoms from teething. Infants cut their teeth 
more easily and readily in winter than in summer ; boys more 
difficult than girls. What is to be apprehended is the reflex 
condition, which affects all children to a greater or less degree. 

Treatment. — The irritation of teething causes the gums to 
swell and become tender to the touch ; there is fever, with irri- 
tation of nervous system, with occasional convulsions. In such 
cases, where the gums are considerably swollen, and the child 
seems to suffer much from the irritation of the tooth in working 
its way out, and when the tooth is near the surface, it will 
be exposed by the retraction of the gum, then it may be advisa- 
ble to relieve it with a lancet ; when no such appearances pre- 
sent themselves, and the child is very restless and uneasy, we 
can do little more than attend to the different symptoms. In 
the mildest forms of dentition, sedation is very useful ; bathing 
twice daily ; put thirty drops of tincture of aconite in half a 
tumbler of water, and give a teaspoonful every one or two 
hours ; if there be strong nervous symptoms, with a tendency 
to convulsions, add a few drops of tincture green root gelsemi- 
num. If the breath is very acid, lime-water and milk, or the 
neutralizing mixture, or ozone-water; if there seems to be 
griping, open bowels with cascara, and follow with infusion of 
anise-seed. The above also will relieve the bowels if constipated. 
In some cases a grain of leptandra rubbed up in pulverized 
licorice is very efficient. If there is restlessness, violent start- 
ings, with screaming and twitchings — precursors of convulsions 
— bromide of potass and ammonia in lavender or cinnamon- 
water. 

Opium, or laudanum, or paragoric, should not be adminis- 
tered to teething infants for the purpose of keeping them quiet. 
It is a most injurious practice — dries up their secretions, and 
whittles down their vital force. Mothers, and especially nurses, 
are prone to resort to that drug in some soothing syrup, so as 
to have their own rest undisturbed. The only drugs of real 
merit are lime-water in milk, compound hypophosphites of 
lime and soda in juice of raw meat, and ozone-water; two of 
which could be given at alternate periods, say, every two hours ; 
otherwise the treatment must be upon general principles. If 
there is fever, aconite, and asclepias should be given ; urine 
scanty and high-colored, parsley-root tea and sweet spirits of 
nitre. Watch convulsions ; let mother have tincture of lobelia 
on hand, and if she sees twitchings or throwing head back, 
alternate pallor and redness, administer a few drops as occasion 



THE CHILD — ITS DISEASES. 743 

demands. A free action of the bowels during dentition should 
not be stopped — not unless the motions are very frequent, and 
then guardedly. Any other symptom that arises should be man- 
aged upon general principles. The practice adopted of giving 
infants toys made of hard rubber or ivory to suck and hold 
in the mouth, upon which they can press their gums during 
teething, is highly improper, as it has a tendency to harden 
the gums. 

Aphthae, or Nursing Sore-Mouth, is most common in ill- 
fed children, and the parasite present often makes destructive 
ulceration of the gums. (See Aphthae.) Pure air, proper exer- 
cise, wholesome, nutritious milk; flannel clothing, regular bath- 
ing, secretions, and everything that is calculated to promote 
good health, will greatly contribute to the safety of dentition. 
At the same time guard the reflex centres, by keeping them 
well stimulated by proper means. 

In all cases of tardy, difficult, or painful dentition, we must 
?iever ignore the main defect — a want of histo-genetic material 
in the blood ; provide in all cases material from which the 
system can elaborate teeth. 

Weaning Brash is a term appled by mothers and nurses to a 
disorder that takes place upon being suddenly deprived of the 
mother's milk by disease, pregnancy, or death, or where chil- 
dren are reared artificially with bad milk. The use of the 
milk-food has stamped this disorder out. It consisted in de- 
rangement of the stomach, vomiting, and purging, with green 
stools; and if it occured during the hot weather, speedily 
merged into that fatal disease, cholera infantum, with its sequel, 
tabes mesenterica. A quick transition from one kind of food 
to another should never take place ; it should be progressive, 
and adapted to the age and condition of the child. 

MALFORMATIONS AND DEFORMITIES, 

Some attribute them to impressions made upon the mother 
during pregnancy, and there is no doubt but this is a fruitful 
source; others attribute them to defects, or deficiencies, or ab- 
sence of certain histo-genetic material in the body ; and others, 
to a variety a£ causes. But there can be little doubt that by 
far the most prolific causes of deformities are incompatibility of 
temperament, close consanguinity, in-and-in-breeding. Al- 
though this is the main source of the trouble, it would be well 
in our present state of civilization, where the nervous system 
is developed at the expense of the physical, where the brain is 
alive, vivid to external impressions, to guard pregnant mothers 
from theatre scenes, deformities, animal or fowl killing, choreac 
movements, fits, appalling accidents, death, or anything of an 
unfavorable nature that would be likely to impress her keenly 



744 THE CHILD — ITS DISEASES. 

or acutely. Defects or mutilations may also be classed under 
the same causes. Imbecility, an abrogation of the facial angle 
of 45, or idiocy, is likely to be due to the use of whisky and 
tobacco by the father, the former causing true imbecility, the 
latter wiping out the typical convolutions of the brain. 

As a rule, all extra fingers, and toes, and other malforma- 
tions, should be rectified at birth. 

Tongue-Tie. — The tongue may be unnaturally adherent to 
the sides, or to the under surface of the mouth, so that nursing 
may be prevented. The adhesions must be carefully and cau- 
tiously divided with a bistoury and the bleeding controlled by 
the perchloride of iron. Genuine tongue-tie is when the bridle 
of the tongue is so short as to reach nearly to its tip and inter- 
fere with its motions. This is to be remedied by dividing the 
edge of the bridle with the scissors. 

Hare-Lip. — The simplest degree of this deformity is single 
hare-lip, in which the lip is fissured on one side; it may be 
complicated, with partial or complete fissure of the palate. The 
greatest malformation of this kind is double hare-lip and fissure 
of the palate. The arrest of development occurs only in the 
upper lip ; the fissure never occurs in the median line, but 
always under one or both nostrils, and the deformity may vary 
from a notch to a complete fissure, extending into the nostrils. 
The only point of interest is the treatment. The operation for 
the relief of this difficulty should be performed immediately 
after birth. The child, after being properly nourished, should 
be wrapped up in a sheet; the edges of the cleft should be lib- 
erally pared, and then hare-lip-pins inserted two thirds the 
thickness of the lips, from its anterior face. A sufficient num- 
ber of pins should be used, and over each, the figure 8, formed 
of lead wire, which should have the preference to silk. 

Cleft Palate. — Is often associated with hare-lip, and fre- 
quently closes when the lips are healed. The operation for 
this has generally to be delayed till patient becomes ten or four- 
teen years of age, or even older. 

Wry-Neck. — A distortion in which the head is drawn to one 
side, and the face to the opposite ; due to the contraction of one 
sterno-mastoid muscle. Paralysis of one muscle allows the 
other to overpower its fellow. 

Causes. — Blows on neck; caries of cervical vertebrae ; en- 
largement of cervical glands on one side; to the cicatrix of a 
burn or ulcer ; rheumatism ; gout. 

Treatment. — Varies much, but generally embraces altera- 
tives and tonics, with shampooing, friction, electricity of the 
paralyzed side. Try every means to improve general health ; 
all failing, the muscle on sound side to be divided. 



THE CHILD ITS DISEASED. 745 

Knock-Knees. — Is due to a relaxation of the internal lat- 
eral ligaments of the knee-joints, allowing femur and tibia to 
become separated, so that an angular obliquity of the bones 
results. It is common in tubercular children ; may be noticed 
before beginning to walk. The best plan is to treat for tuber- 
cular, and resort to every means to build up the general health. 
Massage localh T , twice daily. 

Bow-Legs. — Belongs essentially to rickets, and is generally 
due to the starch-feeding of infants. It can be overcome by a 
better diet, one containing vegetable phosphates, as corn and 
oat-meal mush, boiled white-fish, animal food, etc.; keeping 
patient off his feet, and in addition, using locally, massage, 
salt-water baths, and general treatment for tubercular. Perse- 
verance is essential, as many months are indispensable for a 
cure. 

Club-Foot. — A gradual change in form and positions of tarsal 
bones, chiefly owing to undue action, or paralysis of certain 
muscles, or their atrophy, or want of development, or to con- 
traction of tendons. Usually congenital, and dependent on 
same causes as other malformations ; or it can be acquired by 
conditions affecting either the circulation of nerves, or growth 
of muscles. There are quite a number of varieties, but for all 
practical purposes they may be embraced under four principal 
heads. 

(1.) Talipes Equinus : This is the most common form, and 
consists either in a rigid contraction of the tendo-achillis, of 
the muscles of the calf of the leg, so that the heel cannot be 
brought to the ground, and the patient walks on the metatar- 
sal bones. When this is not congenital, it is liable to occur 
during dentition, from worms, acidity, and other reflex causes 
of irritation. The patient, either from incompatibility, or other 
causes, is very tubercular ; and the slightest irritation in the 
body is transmitted to the weakened nerves. A cure is easily 
effected by a division of the tendo-achillis under the skin. 

(2.) Talipes Varus: The heel is raised, the inner edge of the 
foot is drawn upwards, and the outer edge rests on the ground. 
In extreme cases, patient walks on dorsum of foot and outer 
ankle. There is contraction of the muscles of the calf and ad- 
ductors of the foot. Every tendon that aids in producing the 
deformity should be freely divided under the skin, and, last of 
all, the tendo-achillis. 

(3.) Talipes Valgus: This is the direct reverse of the talipes 
varus. The outer edge of foot drawn upwards, so that patient 
rests on inside of instep and inner ankle. All the tendons 
that are concerned in producing the deformity are to be cut 
under the skin. 

(4.) Talipes Calcaneus: Elevation of the toes and falling on 



746 THE CHILD — ITS DISEASES. 

the heel, so that the patient walks on the latter. This is 
usually brought about by loss of nerve-power, or degeneration 
of the muscles of the calf, which affords the opposing muscles 
a chance of drawing the foot into the abnormal position. 

Every tendon to be divided subcutaneously, so as to bring 
the foot into its proper position. 

The principal upon which the tendons of the various muscles 
are divided, is very simple : A cut, or incision, is made under 
the skin, so as to prevent any suppuration — the cut surfaces, 
or ends, although stretched apart quite a space, heal by connect- 
ive tissue or lymph, which lengthens the tendon the amount de- 
sired. It is necessary to wear a boot if performed at birth, as 
it ought to be, or a week after. 

When not congenital, but coming on during childhood, many 
cases can be cured without operation by the removal of the 
source of the irritation, by good food, fresh air, sea-bathing, 
tonics, and by shampooing, friction, or massage, with oil, and 
a proper use of bandages, splints, boots, adhesive plasters and 
the like. Rheumatism and gout should be carefully guarded 
against. We cannot too strongly insist upon a most construct- 
ive treatment as the best means of overcoming the true cause 
of the difficulty. 

Flat Foot. — A sinking of the sole of the foot from relaxa- 
tion of the supporting ligaments. Walking is rendered awk- 
ward, slow, painful, and in bad cases, lameness and deformity. 
It is usually the result of debility, and can be remedied by 
the mother when the child is quite young, by bathing, friction, 
and good nutrition. 

Webbed Fingers and Toes. — In rectifying this malforma- 
tion, the best plan is to make a small incision at the junction 
of fingers or toes, through which introduce a piece of lead rib- 
bon which should be permitted to remain about ten days, so as 
to give ample time for healing. Then remove and slit up the 
web its entire length, and dress with the lead ribbon, or other- 
wise. If the above method is not observed the webbing often 
returns. 

THE NUTRITION OF THE INFANT. 

Milk is the natural food of the infant up to the period when 
it is supplied with teeth for mastication. Its stomach is adapted 
solely for its digestion, and it is the only proper element for 
building up the body. Milk, if healthy, supplies everything 
for the whole organism, from which bone, muscle, brain, gland, 
etc., can be constructed, repaired, and renovated. Milk is pre- 
eminently suited for the rapid oxidation, increased tempera- 
ture, accelerated respiration and circulation, the only diet for 
building up infant organization. The milk taken by the child 



THE CHILD ITS DISEASES. . 747 

represents so much potential energy ; but before that energy can 
assume a vital form, the food must be converted into tissue, and 
in that conversion a large amount of energy must be expended. 
All the constructing and repairing powers in the infant are 
more active than in the adult. The infant requires, over 
and above the wants of the man, not only food for flesh laid 
on, but also for the energy used in making up that living, 
sculptured flesh out of materials that serve for food. In the 
growing organism there is a greater instability in the nutritive 
process, and this instability must be guarded against by having 
good milk, else w r e w T ill have defects in blood-formation. Ameri- 
can mothers have been accused of being bad nurses. Now, this 
is both true and false ; true, she is highly civilized, quick, ex- 
citable, and often, in the act of nursing, allows care, worry, to 
distract her attention ; will hastily lay her little one down before 
it has even partially emptied the breast, which act of all others 
causes the milk to dry up ; true, she is absorbed in lectures, 
theatres, balls, and other frivolities, which engender late hours 
and irregularity, which has a depressing effect upon her; and 
her literature is not good ; true, her diet is not the proper kind 
or quality for a nursing mother, her ices, ice-cream, iced drinks, 
candies, pastry, etc., are pernicious and highly detrimental to 
the secretion of milk ; but let her remove these and other de- 
fects, she is as good a nurse as any other mothers of her race. 
Take the American mother, free from toil, care, struggle for 
existence ; free from the vices and depressing influences of city 
life, with a good diet of beef, mutton, poultry, game, eggs, milk, 
oatmeal porridge, corn-bread, carrots, parsnips, fruit, and other 
vegetables, she is a good nurse. Excess of feeding, alcoholic 
or malt liquors, wines, and sloppy food, never should be recom- 
mended ; neither is tea or coffee of any utility. 

The nutrition of the child is of the greatest importance, be- 
cause in all our large cities w T e lose two-thirds of our entire 
infantile population during the first two years of existence, 
chiefly by bad milk, careless or improper nursing, insufficient 
food, and insanitary conditions. The mother's milk is too often 
deteriorated by fashion, theatres, improper food, worr}^, work, 
and other causes, and the want never can be supplied by artifi- 
cial means, for there is no substitute for the life-giving mother's 
milk. If we could only teach mothers how much suffering they 
could save, how many valuable lives they could prolong, by see- 
ing that their children have proper food, it would be a holy task. 
Many modern mothers can only nurse their children partially, 
or not at all. Their milk is often deficient through improper 
diet, and not emptying the breast properly ; besides, the secre- 
tion decreases by care, worry, struggle, w r ork, or her health 



748 THE CHILD ITS DISEASES. 

may be feeble, or delicate; or her vital energies taxed by some 
latent condition, that she may have no milk. 

In this condition the infant must have nourishment ; if rich, 
a wet nurse could be provided ; if poor, the cow's milk, or 
milk-food. 

As regards wet-nurses, there is always great danger to be 
apprehended from them in a moral and physical point of view. 
They are generally unfortunate women, women with hidden 
vices, uneducated, full of prejudices and disease, and the irregu- 
larity of their past life has a bad influence on the milk and 
moral well-being of the child ; and it is doubtful, rather than 
run risks of moral and physical degradation, whether artificial 
nutrition, administered by its own mother, or some other intel- 
ligent person, properly adapted to its age and development, is 
not the best. Artificial nourishment is often better than run 
the risk of wet-nursing. The great trouble of late years in this 
particular, has been that parties, by advertisements and certifi- 
cates of ignorant physicians, have foisted upon the people an 
immense array of infant food, all chiefly composed of starch. 
Indeed, starch-food is forced upon the mother wherever she 
goes, as a diet for her child. Now, our infants cannot digest 
starch, their stomachs are not made for it, neither have they 
the means of converting it into sugar, like an adult ; so children 
fed upon starch, as rice-flour, farina, Liebig's food, arrowroot, 
starve ; they have no teeth ; their bones and brain are destitute 
of phosphates. God never made a Caucasian infant to eat 
starch ; there is not a trace of it in the white mother's milk 
A Mongolian or Negro, without cerebral convolutions, may 
thrive on it, but never the white race. So, if there must be 
artificial feeding, let us have cow's milk or milk-food ; and 
with greater care, more fresh air, rigid cleanliness, abundance 
of sleep, an avoidance of insanitary states and contagious dis- 
eases, we may be able to raise the child. 

The proper food, then, of all infants, is milk. That gives 
everything wanted — development and growth ; on it they are 
healthy and thrive. The first two months of life, cow's milk 
two-thirds, water one-third, with very little sugar, comes very 
near that of mother's milk. There is still a difficulty here : if 
a cow is fed on pasture alone, the milk is very poor ; but if 
they are fed with cornmeal and bran, in addition to abundance 
of good pasture, the milk is excellent ; and besides, it must be 
seen that the cow is free from foot-disease, or tuberculosis, and 
the milker not affected by syphilis. In all our large cities 
there is much impure milk — milk loaded with diseased germs ; 
besides, nearly all the high-bred cows are affected with tubercle; 
so if matters are not of the purest kind, condensed milk should 



THE CHILD — ITS DISEASES. 749 

be used ; for in the process of manufacturing, the diseased germs 
are destroyed. 

About the third month, nourishment should be more sub- 
stantial ; for that is the period for true, rational nourishment 
to be given for the future welfare of the child. Dr. Gerber has 
placed before the American parents a nourishment for children 
at this perid that is unsurpassed, and satisfies all the physio- 
logical and chemical demands. It consists of the best milk, 
the wheaten phosphates, no starch, best cane-sugar, and a nor- 
mal quantity of saline matter. The combination is perfect, 
and the most appropriate for infant-food, and of immense 
value as an article of general nutrition. It is highly nourish- 
ing, its composition is pure, fresh, superior to anything ever 
introduced ; it is very easily digested ; keeps well, never fer- 
ments or sours ; and is better than city milk, because it is free 
from all diseased germs. Besides, it nourishes brain and bone 
well, consequently teething is easy; excellent for debility; chil- 
dren and invalids never tire of it, but rapidly increase in flesh 
and strength upon it. It is so excellent in teething that they 
come easy, regular, without suffering ; no diarrhoea, or vomit- 
ing, or skin eruptions. It supplies a long-felt want, to wit : a per- 
fect form of artificial nutrition — the best that has ever been 
offered in the world. The milk-food is intended to be used 
when the infant is about from two to three months old. Its 
superiority consists in its containing no starch, which has been 
so detrimental to the digestion of children ; and to the fact that 
bone and brain elements in it are abundant. 

As soon as the child has completed its dentition, the mouth 
salivary glands, stomach, and pancreas, become gradually adap- 
ted to digest solid food, and a change or transition from milk- 
food should be very progressively made. Modern children are 
permitted by both parents to take the ordinary course of the 
house, which is a great wrong on the part of the parents. For 
example, the use of tea and coffee by children is very injurious, 
as it overstimulates and exhausts their nervous S}^stems ■ gives 
rise to catarrh of the stomach in their period of infancy, and 
predisposes them to dyspepsia and cancer of stomach in more 
mature years. The use of sweets, ice-cream, pastry, dumplings, 
is also improper food, because the gastric juices are not strong 
enough for their dissolution ; so also with pork, veal, cabbage, 
nuts, salt fish, and corned beef, totally unfit for the diet of a 
child. Children should be early taught the injurious effects 
of drinking at meals. Whatever fluids are necessary should 
consist of milk or water. A new system of dietetics should be 
inculcated, or rather, an old method revived, among the chil- 
dren. All, irrespective of sex, or condition in life, should, 
from weaning, up till twenty-one years of age, have a special 



750 THE CHILD — ITS DISEASES. 

diet — one of brain and bone-elements ; one hearty meal daily of 
oatmeal porridge and milk or cream. This should be a daily 
meal from September 1st to May 1st; during the very hot 
months of the summer better to discontinue its use, as it is 
somewhat heating. Corn-bread, made without baking-powder, 
should be a daily and staple article of diet; boiled white-fish 
and home-made bread. Bakers' bread, with its noxious com- 
pounds of soda, tartaric acid, alum, sulphuric acid, etc., is unfit 
for child-food, as the phosphates are destroyed in the process 
of whitening. The oatmeal, corn, and fish diet should be 
insisted on, as calculated to promote the nutrition of brain and 
bone. No baking-powders should be tolerated in the culinary 
department of any family, as their use is destructive to the 
phosphates in all our cereals. To the toothless babe starch diet 
is starvation, but after dentition is completed they can digest 
starch ; but in our climate, with its highly oxygenized atmos- 
phere, our children do not require much starch-food, such as 
potatoes, arrowroot, tapioca, rice ; there are no brain elements 
in them — not of thought ; they are converted into sugar, and 
thus into calorification — a process not very essential to the pre- 
cocious American; so, as a rule, they should be sparingly fed, 
Carrots, parsnips, onions, vegetables, and ripe fruit generally, 
are conducive to health and longevity in the child. 

The Child — its care and culture, warding off and curing its dis- 
eases, must be carried out on physiological principles. In look- 
ing at the dawning intellect, we must remember that mind is 
brain-function, just as locomotion is one form of muscle-func- 
tion. The brain, as it matures, acts, thinks, reasons, judges, 
and forms purposes. As the size, weight, form, and development 
of the bony skeleton, with its muscular apparatus, determine 
the limits and nature of physical power and activity, so do 
the size, weight, form, and development of the brain, w 7 ith its 
apparatus of sense-organs, determine the limit and nature of 
intellectual power and activity. Its personal characteristics are 
passed down from the parents ; so that there are mental and 
moral qualities offering themselves for care and culture. The 
aggregate qualities of the parents, embodied in the child, are 
subject to surrounding influences. It is essential to recognize 
this initial fact, so as to develop the good, and repress the evil 
elements of its nature. Every child is charged with potential 
energies that need to be stimulated for good, trained and taught 
in a manner and upon a principle peculiar to her or himself — 
the infiuences brought to bear upon it; the tasks imposed; the 
exercise of its body and mind — its regime, selected and gradu- 
ated to its undetermined nature, and its special needs. 



EMERGENCIES, AND THEIR TREATMENT. <0 



EMERGENCIES, AND THEIR TREATMENT. 



HEMORRHAGES. 

External haemorrhage must be arrested by presssure, by 
tying a bandage around limb, and using torsion till medical 
aid is reached. 

Haemorrhage from the Nose. — Raise both arms above the 
head, apply cold — ice, if possible, to the nape of neck and over 
nose, and if necessary plug the nostrils with cotton saturated 
with vinegar. 

Haemorrhage from the Stomach. — A solution of common 
salt ; small pieces of ice ; gallic acid ; digitalis ; gelseminum. 

Haemorrhage from the Lungs. — A solution of common 
salt ; tincture of iron ; digitalis ; gallic acid ; solution of alum ; 
ice. 

Haemorrhage from the Bowels, — Turpentine; sulphuric 
acid; digitalis; bayberry. 

Haemorrhage from the Kidneys. — Heat to loins; gelse- 
minum in infYusion of uva ursi ; gallic acid; ergot; if bladder 
is full of clots, wash it out. 

Haemorrhage from the Uterus. — If it occurs during un 
married life, from fright, shocks : rest ; elevation of pelvisand 
foot of bed, head low; digitalis; gallic acid; turpentine and 
sulphuric acid ; no hot drinks or food ; perfect quiet. 

Haemorrhage Before Delivery. — Rest in recumbent pos- 
ture, hips elevated, foot of bed raised, head low; opium in 
alternation with the viburnum compound ; nothing hot, no 
excitement. 

Haemorrhage After Delivery. — Patient well bandaged from 
middle of thighs to above the navel; compress over uterus; ele- 
vation of hips and foot of bed ; no excitement, nothing heating. 
If the contents of uterus are removed, there is not much likeli- 
hood of hsemorrhage. If uterus has contracted on after-birth, 
or a portion of it, plug vagina with a sponge, or sponges, satu- 
rated with vinegar, which will excite contraction, and violent 
pain, and expulsion. Give uterine stimulants, as capsicum in 
warm milk; quinine; but avoid ergot, if possible. If uterus 
dilates sufficiently, remove after-birth, or clots, with fingers. 
Don't give the turpentine mixture till all has been remo\ ed ; 
then it is very useful. 



752 EMERGENCIES, AND THEIR TREATMENT. 

Haemorrhage in which the After-birth is over the Mouth 
of the Uterus, or Placenta Praevia. — Plug the vagina with 
sponges ; if that fails, dilate the neck, detach enough of the 
placenta to admit the hand, rupture membranes, seize the feet, 
and bring down, and hurry up delivery by internal and local 
stimulants. There must be no wait or hesitation. 

Contusions, or Ecchymosis. — Arnica, marigold, muriate of 
ammonia, leeches. 

WOUNDS. 

Wounds of the Throat. — Arrest the flow of blood by pres- 
sure and ligature. 

Wounds of the Chest. — Haemorrhage should be controlled 
by internal remedies. In some cases the intercostal arteries can 
be ligated. Wounds of the heart are not always fatal. 

WWnds of the Abdomen. — Generally either punctured or 
incised. If bleeding is profuse, tie the vessels, if they admit of 
it. If the intestines protrude, return them ; and if the wound 
is not large enough for the purpose, enlarge it. If they are 
wounded, stitch them carefully up and return, carefully spong- 
ing away any blood or escaped faeces. 

Wounds of liver, kidneys, bladder, are very fatal. 

Wounds of the Perinseum. — Hurried labor, want of support, 
ignorant use of the forceps, ergot, and other causes, render the 
perinseum liable to be frequently torn or lacerated. As soon 
as the lochial discharge ceases, edges to be carefully pared and 
stitched up. 

Gun-shot Wounds. — Must all be treated on general princi- 
ples. The essential features are to rouse the patient from the 
state of collapse, control haemorrhage, and, when prostration is 
overcome, foreign bodies, particles of bone, pieces of clothing, 
bullets, splinters of wood, or other matter, are to be removed or 
extracted, and the wound treated on general principles, with 
antiseptic dressing. Patient kept well over on it to allow for- 
eign bodies, or morbid matter, to flow out by gravitation. 

Limbs Torn by Marching, or other Violence.— Tie strong 
handkerchief around sound part, and use torsion to prevent 
haemorrhage until surgeon arrives. 

In all accidents, arrest the haemorrhage before moving the 
patient. If unable to walk, some conveyance — a settee, or litter, 
or carriage, according to the nature of the case. 

The injured person should be taken to nearest hospital, or 
house ; clothes ripped up, so as to uncover them and ascertain 
the extent of the injury ; all onlookers excluded. 

The great point is, if there is a wound, to arrest the flow of 
blood by compressing the limb above the injury sufficiently 
tight until a surgeon arrives. 



EMERGENCIES, AND THEIR TREATMENT. 753 

Foreign Bodies in the Air Passages. — Foreign bodies, as 
seeds, beans, fruit-stones, buttons, pins, coins, beads, marbles, 
pebbles, fish-bones, etc., may pass into the larynx, trachea, and 
bronchi of children ; or vomited matter, pus from abscess, and 
other substances. 

The entrance of a foreign body from without usually takes 
place during a sudden, strong, deep inspiration. It at once causes 
violent spasmodic cough, difficulty of breathing, a sense of 
impending suffocation, or even immediate death. In a few 
minutes s} r mptoms become less severe ; cough and difficulty of 
breathing return at intervals. If the body remains in the 
larynx, there will be harassing cough, of a suffocative character; 
loss of voice ; an inability to speak above a whisper ; pain in 
swallowing ; tenderness ; noisy, hissing, respiration, with diffi- 
culty of breathing. If it descends into the trachea, it is seldom 
stationary, can sometimes be felt by the hand externally to rise 
and fall ; the change in position gives rise to severe spasmodic 
attacks of difficulty of breathing; a flapping, valvelike sound, 
owing to a foreign body being forced against the rima glottidis, 
in expiration. If the substance passes down the bronchial tubes, 
it fortunately takes to the right, directed by the bronchial sep- 
tum. Auscultation and percussion will reveal the point, whether 
the patient's lung is permeated by air. Bronchitis and pneu- 
monia are now to be dreaded. 

Fluids may enter the larynx, but they usually induce a sense 
of choking, with convulsive cough, which causes their expul- 
sion ; but if very abundant, as in drowning, they may cause 
death. 

Treatment. — If the body be at the entrance of the larynx, 
or between the vocal cords, it may be seen, and seized with poly- 
pus forceps. This failing, place the child's head downwards, 
and slap quickly and smartly on back. Emetics, lobelia, and 
snuffs should be tried. 

If the body remains in the larynx, it should be at once 
opened, and the substance will probably be either ejected 
through the glottidis or the artificial opening. If successful, 
the opening should be stitched up, and strips of adhesive plaster 
applied between. 

Various other methods have been suggested, as the inhalation 
of chloroform, hanging patient up by feet, and slapping briskly 
on back. 

Foreign Bodies in the Nose, such as peas, small shot, fre- 
quently occur in children. Excite sneezing, or use nasal douche, 
or, if possible, extract them with the forceps. 

Foreign Bodies in Ear, such as grains of wheat, barley; 
slate-pencil, seeds, insects, cause great irritation. 

Treatment. — In case of insects, fill the ear with alcohol, 

60 



754 EMERGENCIES, AND THEIR TREATMENT. 

turning patient on sound side ; or with vinegar and salt in 
solution, and plug with cotton-wool. Insect will be found usu- 
ally on the plug. Other bodies must be removed by syringing 
out the ear twice daily with tepid water. 

Foreign Bodies in the Eyes, such as sand, cinders, broken 
oyelashes, which often lodge on one of the eyelids. In all cases 
they should be immediately removed, to prevent inflammation. 

Treatment. — Invert the eyelids, and remove the foreign 
body with a small camel's-hair brush, dipped in a solution of 
one grain of chloride of gold to one ounce of water. 

Burns and Scalds. — Vinegar, lard, and flour are in every 
house. Put on flour, beat up in lard, thick, covering the burn 
half an inch. If vinegar is applied, keep constantly wet, and 
as soon as the carbolic acid mixture can be procured, let it have 
the preference for a permanent dressing. 

Shock, or Collapse. — Artificial heat, to feet, inside of thighs, 
and arms; perfect rest, recumbent posture; diffusible stimu- 
lants. If there is no reaction, artificial respiration; cloths, 
wrung out of boiling water, over heart ; enemata of linseed tea, 
with spirits of turpentine; friction to entire surface ; electricity. 

Sun-Stroke, in whatever form, is best treated by placing 
patient in recumbent posture, in a cool room, near an open 
window ; removing his clothes, and keeping tepid water con- 
stantly applied to the entire body ; bromide of ammonium and 
tepid water internally, and also by the rectum. Place the great- 
est reliance upon tepid water and ammonia ; warmer water, if 
skin is cold. 

Retention of Urine. — Hot hip-bath, with lobelia ; tincture 
of gelseminum internally; a poultice of hot, bruised, roasted 
onions to perinseum ; the running of a stream from a narrow 
orifice ; all failing, catheter. 

Dog or Snake-bite. — Apply firmly a ligature above the 
bitten part; bathe it freely with very hot water. While so 
doing, chop a few red onions very fine; then mix in some 
common salt, and bind an inch thick over the wound. A solu- 
tion of muriate of ammonia answers better for a dressing, if at 
hand ; if so, keep it constantly wet, and the solution as strong 
as it can be made ; keep either applied till the physician arrives. 
If a snake-bite, don't wait, but begin administering half a tum- 
bler of the best brandy or whiskey that can be got, every five 
minutes, till patient is perfectly drunk. 

Lightning. — Usually causes instant death by paralysis; 
when not immediate, the tissues may be charred, or simply the 
loss of speech, sight, hearing; or haemorrhage from mucous 
membrane, from eyes, ears, mouth, rectum. General princi- 
ples, according to the condition of the patient. Burns treated 
like other burns; collapse, by stimulants. 



EMERGENCIES, AND THEIR TREATMENT. 755 

INSENSIBILITY FROM VARIOUS CAUSES. 

When an individual has been picked up on the road or street 
insensible, irrational, or inarticulate, and his antecedents un- 
known, what is the matter ? Is he ill, drunk, drugged, or suffer- 
ing from some brain concussion, or from coma after an epileptic 
fit, or otherwise ? 

Syncope, trance, catalepsy, coma, are names used by medical 
writers to designate states of insensibility, which the public call 
fits. 

Syncope is fainting, a condition of the body in which there 
is a death-like pallor, with loss of muscular power and con- 
sciousness ; a faint is usually transitory, due to shock. In it 
the person collapses, rather than falls to the ground ; his knees 
are bent under him, he subsides into the sitting posture, his 
head drops forward, and by the time his head has thus sunk 
to the level of the heart, or below it, the circulation of the brain 
becomes sufficiently restored for consciousness to return. In a 
faint, a person seldom bruises his face. Upon waking, be may 
feel sick, giddy, or alarmed, but his brain resumes its thinking 
functions at once, and entirely. 

Recumbent posture on right side, articles of dress loosened, 
dashing cold water on face and front of chest, cautious inhala- 
tion of ammonia, diffusible stimulants. 

Trance is a state of death-like faintness, in which some con- 
sciousness is retained, but inability to speak. In trance, the body 
appears inanimate, there is no power to move a muscle, the 
limbs are flexible ; he may hear, see, and remember all that 
goes on around him. There is no perceptible pulse or respi- 
ration ; hence trance has been, and often is, mistaken for death, 
as the temperature is lowered; muscles re-act to galvanic stim- 
ulus. There should be no hurried burial alive, or post-mortem, 
unless rigor mortis or signs of putrefaction be present. 

Treat same as Collapse — artificial heat, enemata of turpentine, 
cups to both sides of entire spine, over abdomen ; and as soon 
as he can swallow, diffusible stimulants. 

Catalepsy, a rare inanimate condition ; insensible, stiff, un- 
able to move, or articulate; pulse slow, respirations diminished ; 
extremities cold and flabby. He or she may be pinched, pricked, 
beat without flinching — statue-like, but perfect muteness. There 
is neither the lividity of asphyxia, nor the pallor and geneial 
flexibility of syncope, nor the stertor of coma, nor the paralysis 
of epilepsy, nor the movements and dreamy mental automatism 
of somnambulism. 

Treat same as Hysteria, or Anaemia of Brain, Cord, and Gan- 
glionic Centre. 

Coma, or deep sleep, may be due to very many causes, as to 



756 EMERGENCIES, AND THEIR TREATMENT. 

pressure exercised upon the brain from effusion within the 
ventricles, and outside of the membranes ; to alteration in the 
molecular state of brain from concussion, contusion, apoplec- 
tic extravasation ; to brain-poisoning by insufficiently oxidized 
blood ; to uraemic blood, narcotics, anaesthetics, inebriants. 

It is impossible to give accurately positive land-marks for 
diagnosing each kind of coma. 

Profound Coma is present in serous effusion into the ventri- 
cles of the brain, such as arises from extensive burns, or from 
tubercular meningitis in later stages. Patient is first sleepy, 
then drowsy, then stupor, slow of comprehension, difficult to 
wake, and finally, incapable of being roused at all. The breath- 
ing is stertorous ; at first he can swallow, then he fails to do so ; 
pupils are not characteristic, most frequently contracted, and 
then dilated. 

Coma, due to fracture or effusion of blood, as in sanguineous 
apoplex\ r , is sudden in its advent. The breathing is stertorous, 
pupils contracted, heat may be normal, skin perspires freely. 
In fracture of the skull, there is oozing of blood or serum from 
ear and nose ; or there may be blueness, humidity, ecchymosis 
of the eye, neck. In apoplectic cases, face often turgid with 
blood. 

Coma, due to molecular death of a portion of the brain, the 
face is pale, heat lowered, pupils unequal, evidence of hemi- 
plegia, or some form of paralysis. 

Coma, due to some brain-poisoning, as deficiency of oxygen 
in pneumonia; nitrous oxide gas; the nose, lips, neck, face, and 
other parts, are livid, often black. 

If patient has breathed carbonic acid gas, say, from a lime- 
kiln, or sulphuretted hydrogen from some source, those two 
gases arrest the oxygen-carrying properties of the blood, and 
this blood-change, or damage, is not recoverable from brain- 
poisoning; and coma by anaesthetics and inebriants is usually 
detectable by the breath of the comatose person. Apoplexy 
and dead-drunkness are often mixed. 

In Brain-Poisoning, try artificial respiration, abundance of 
fresh air, cloths out of boiling water over heart; enemata, say, 
one and a quarter pints of cold or warm water, with a table- 
spoonful of salt; cups to nape of neck; mustard to feet and 
hands; free purgation, if he can swallow. 

Uraemic Coma is recognized by oedema of eyelids, or extrem- 
ities ; wax-like pallor, urniferous odor of breath and skin, furred 
tongue, pearly conjunctiva, dilated pupils. 

Try warm bath, free purgation with salines, and hypodermic 
injections of pilocarpine. 

Coma of an epileptic fit is usually recognized by the bruises, 
torn or soiled clothes ; indications, as if the tongue was bitten. 



EMERGENCIES, AND THEIR TREATMENT. 757 

Patient to be placed on right side, clothes loosened or removed ; 
enemata of lobelia, capsicum, and valerian ; or hypodermic in- 
jection of one-fourth of a grain of sulphate of morphia, if over 
seventeen years of age ; dashing cold water on the patient, of 
little service. 

Opium Coma. — Profound stupor, closed eyelids, contracted 
pupils, upturned eyeballs, pale face, cool, clammy skin, fore- 
head beaded with heavy perspiration, limbs lax; breathing 
slackens, reaching as low an ebb as six per minute ; coma pro- 
found ; no responsive movement to pricking, pinching, or other 
stimulation. The body will not walk, it is only dragged ; lips 
become livid, surface colder, breathing, at long intervals, and 
pulse, nearly imperceptible. This coma mav be mistaken for 
effusion into the pons ; so it is well, in all cases of profound 
coma, with contracted pupil, to exercise care, unless there be 
collateral evidence — as a laudanum or morphia bottle — about, 
or marks of a hypodermic syringe, lest the case be apoplexy 
into the pons — a kind of coma that is not benefited by basti- 
nado, beating with wet towels or willow rods, walking about, 
or all the caffeine, or coffee, pumped into the body. In all 
cases of effusions, fracture, apoplexy, adhere to cups to nape of 
neck, stimulants to extremities, open bowels. (See Opium.) 

ASPHYXIA, 

This term is generally used to designate suspended animation, 
produced by the non-conversion of the venous blood of the 
lungs into arterial. The supply of air being cut off, the un- 
changed venous blood of the pulmonary artery passes into the 
minute radicles of the pulmonary veins, which require arterial 
blood to excite them; more or less stagnation takes place in the 
pulmonary capillaries, and death frequently ensues from this 
cause. Besides, the non-oxygenized blood is very poisonous to 
the brain, and has no stimulus to the ventricles of the heart. 

Causes. — Whatever prevents the ingress of air into the 
lungs, as effusion of lymph in acute laryngitis ; congestion of 
the lungs in pneumonia; drowning, strangulation; obstruction 
of the larynx by foreign bodies ; inhalation of chloroform, car- 
bonic acid gas, other poisonous gases ; narcotic poisons ; injuries 
to the medulla oblongata ; dislocation of the spine in cervical 
portion. 

In all forms, the treatment resolves itself into the removal of 
foreign bodies, or water ; allowing an ingress of pure air into 
the lungs ; and in inducing warmth and circulation. 

Asphyxia from Drowning. — The first effect felt by a drown- 
ing person is an urgent feeling of anxiety in the chest ; the 
pulse becomes weak ; the respirations become less, and the blood 
of a venous hue. The venous blood acts as a narcotic poison 



758 EMERGENCIES, AND THEIR TREATMENT. 

on the brain — produces insensibility, loss of voluntary motion; 
surface becomes of a livid hue; the heart ceases to beat; the 
sphincters relax ; body sinks to the bottom. 

If life is utterly extinct, the pupils are dilated, jaws clenched, 
fingers and thumbs contracted, face pale. 

Reanimation may take place from five minutes to three- 
quarters of an hour after immersion. 

Asphyxia from Strangulation. — The first effect of tighten- 
ing the cord around the neck, is the suspension of respiration, 
and engorgement of the brain with blood ; then sensibility 
decreases; epileptic convulsions come on — suffusion, lividity, 
turgidity of the face and upper part of the body; eyes open; 
features distorted ; hands clenched ; sphincters relaxed. If 
the air is not perfectly excluded, the sufferings are : engorge- 
ment of head and brain greater. The action of the heart 
becomes more active as the death-struggle progresses, and con- 
tinues beating after respiration has ceased. 

Asphyxia from Poisonous Gases. — Carbonic acid gas is 
the most common — burning charcoal. 

The usual symptoms being a deep sleep, with intense, throb- 
bing headache, with weight and heat, especially about back of 
head ; strong pulsations and tightness across the temples ; ver- 
tigo ; increased action of the heart, and often violent palpitation ; 
confusion of ideas ; failure of memory ; nausea ; hysteric sob- 
bing. If the vapor has been breathed for some time, the symp- 
toms will be: noises in the ears, partial or total loss of vision, 
disturbance of the senses. 

Asphyxia, under the above conditions, depends upon accumu- 
lation of carbonic acid gas in the lungs, the want of oxygen in 
the blood — the natural stimulus of living tissue. 

Appearances which Indicate Death. — Total suspension of breath- 
ing, and heart's action ; eyelids half closed and pupils dilated ; 
jaws clenched; tongue appearing between teeth, with frothy 
mucus about the mouth and nostrils ; fingers semi-contracted, 
with coldness and pallor of the surface. 

Treatment of Asphyxia from Strangulation or Suffocation, Anaes- 
thetics, Gases, etc. — 

Rule 1. To Maintain a Free Entrance of Air into the Wind- 
Pipe. — Cleanse the mouth and nostrils ; open the mouth ; draw 
forth the patient's tongue, and keep it forward ; an elastic band 
over the tongue and under the chin will answer this puroose. 
Remove all tight clothing from neck, chest, or waist. Make 
sure that there is no foreign body lodged in pharynx, larynx, 
or oesophagus. If water is there, place patient on abdomen, 
over a hogshead, and give half dozen rapid rolls. Then 

Rule 2. To Adjust the Patienfs Position. — Place the patient 
on his back, on a flat surface, inclined a little from the feet 



EMERGENCIES, AND THEIR TREATMENT. 759 

upwards ; raise and support the head and shoulders on a small, 
firm cushion, or folded article of dress, placed under the shoul- 
der-blades. Supposing natural respiration has ceased, proceed — 

Rule 3. To Imitate the Movements of Breathing. — Grasp pa- 
tient's arms just above the elbows, and draw the arms gently 
and steadily upwards, until they meet above the head. (This 
is for the purpose of elevating the ribs, and thus expanding the 
chest, and drawing air into the lungs.) Pressure on the breast- 
bone will aid this. Repeat these movements alternately, delib- 
erately, and perseveringly, fifteen times in a minute for two or 
three hours, or until a spontaneous effort to respire is perceived ; 
immediately upon which, cease to imitate the movements of 
breathing, and proceed to induce circulation and warmth. 
Should a warm bath be procurable, the body may be placed in 
it up to the neck, continuing to imitate movements of breath- 
ing. Raise the body in twenty seconds in a sitting posture, 
and dash cold water against chest and face, and pass ammonia 
under the nose. Patient should not be kept in the bath longer 
than five or six minutes. 

Rule 4. To Excite Inspiration. — During employment of above 
method excite nostrils with snuff, or ammonia; or tickle throat 
with a feather. Rub chest and face briskly ; dash, alternately, 
hot and cold water on them. 

Rule 5. To Excite Circulation and Warmth. — Wrap patient in 
dry blankets, and commence rubbing limbs upwards, firmly 
aud energetically. Friction must be continued under dry 
blankets or over dry clothing. 

Promote warmth of body by application of hot flannels, bot- 
tles, or bladders of hot water ; heated bricks, etc., to armpit, 
over stomach and heart, between thighs and to soles of feet. 

On restoration of life, when power of swallowing has returned, 
a teaspoonful of warm water, warm brandy and water, or cof- 
fee, should be given. Patient should be kept in bed ; disposition 
to sleep encouraged. During reaction, large mustard plasters 
to chest and below shoulders will greatly relieve distressed 
breathing. 

In cases where the base of the brain is weak, or where the 
narcotic, or gas, or anaesthetic operate with peculiar violence 
upon that part of the nervous organism, the jaws become not 
only clinched, but immovably rigid, so that the mouth can- 
not be opened; then the following method of resuscitation must 
be enforced. It is of special utility to the drowned. 

The Method of Artificial Respiration for the Treatment 
of the Drowned. — Bide 1. The moment patient is taken out 
of the water instantly turn him downward, with a large, firm 
roll of clothing under stomach and chest. Place one of his arms 
under his forehead, so as to keep his mouth from the ground. 



760 EMERGENCIES, AND THEIR TREATMENT. 

Press with all your weight for three or four, or five seconds, 
each time upon the patient's back, so that the water is pressed 
out of lungs and stomach and drains freely out of mouth. Then : 

Rule 2. Quickly turn patient, face upward, with a roll of 
clothing under back, just below shoulder-blades, and make the 
head hang back as low as possible. Place patient's hands above 
his head. Kneel, with patient's hips between your knees, and 
fix your elbows firmly against your hips. Now, grasping lower 
part of patient's naked chest, squeeze his sides together, press- 
ing gradually forward, with all your might, for about three 
seconds, until your mouth is nearly over patient's mouth; then 
with a push, suddenly jerk yourself back Rest about three 
seconds; then begin again, repeating these bellows-blowing 
movements with perfect regularity, so that the foul air may be 
pressed out and pure air drawn into the lungs, about eight or 
ten times per minute, for at least one hour, or until the patient 
breathes naturally. 

Note. — The above directions must be used on the spot, the 
first instant the patient is taken from the water. A moment's 
delay and success may be hopeless. Prevent crowding around 
patient, as abundance of fresh air is important. Once he 
breathes be careful not to interrupt it. If they are very long- 
apart, carefully continue between them the bellows-blowing 
movements, as before. After breathing is regular, let patient be 
rubbed dry, wrapped up in warm blankets, a little brandy and 
water can be given in small occasional doses, and then be left 
to rest and sleep. If no physician is near, any bystander can 
carry out those rules, as it requires no expert. 

The above method is undoubtedly the best for the ejectment 
of fluids from the stomach and thorax ; with it there is no 
need in opening the mouth, which is usually closely clinched, 
and of drawing the tongue forward, which is impossible, the 
position of the patient obviating this necessity. The com- 
pression is most complete, and capable of the most delicate 
adaptation ; it can be performed by one person in almost any 
situation, and continued as long as there is any use. It is the 
essential method in drowning, as it empties the water-logged 
thorax, relieves the filled bronchi, releases the immovable dia- 
phragm, and thus makes respiration possible. 

In the first position, with a roll of clothing under the stom- 
ach and thorax, makes shoulders the highest point ; the nostrils 
and mouth the lowest. The displaced fluids run downwards, 
cleansing the upper air passages, which are perfectly drained. 
Then the pressure upon the back causes a complete ejectment 
of the fluid, and we have a free passage for air established ; an 
open air-way, and imitation of the natural movements. 

The best method of compression is to place the thumbs at 



EMERGENCIES, AND THEIR TREATMENT. 761 

the bottom of the cartilages of the ribs along their front part. 
The force then applied to the ribs is through the medium of 
the thoracic walls, so distrbiuted as to give no shocks, no 
violence, but cause the ribs to move in their intercostal space?. 

A person of the most average intelligence can easily under- 
stand the two rules laid down. The kneeling position is not 
tiresome; the parts to be pressed are raised to the hands; the 
weight of the body is the chief force, and there are intervals of 
complete rest. It is true, the rate of respiration is one-half slower 
than other methods ; but even with that, there is more oxygen 
supplied than a partially asphyxiated person can breathe, or 
bear, or assimilate ; besides, it has the advantage of allowing 
better diffusion, and minimizes superfluous disturbances. 

It is of especial advantage in drowning, because in that form 
of asphyxia the jaws are inseparably clinched, the slippery 
tongue is receded into the pharynx, and the epiglottis has 
fallen back so that no air can enter, and our first method can- 
not be carried out. It is very doubtful whether it is not the 
best for chloroform and syncope ; it is certainly the quickest. 

In asphyxia from chloroform, same management, but cloths 
wrung out of boiling water over heart, even to vesication. 

Intense Cold. — Cold acts chiefly from without, freezing in- 
wards, causing serous congestion of the three great cavities ; 
with giddiness, inability to see, weakness, and rigidity of limbs; 
almost imperceptible respiration and pulse; tendency to pro- 
found sleep, or coma. Patient must be placed in a room with- 
out fire, and an attempt made at restoration of circulation and 
sensibility, by rubbing the body with snow, or ice, or cold water. 
Frictions with flannels, long continued ; very gradual applica- 
tion of warmth ; a stimulating enema, warm milk, with cap- 
sicum, coffee, beef-tea, or warm wine. 

Syncope. — Fainting, sudden prostration. Remedies are: 
recumbent posture, to slow heart twelve or fifteen beats per 
minute; head low, cold air; cold water dashed over head and 
chest ; smart beating on chest with a wet towel ; friction or 
mustard plasters over region of heart; small quantities of am- 
monia or brandy. 

The syncope in ansemia and chlorosis must be cautiously treated, 
with brandy, wine, carbonate of ammonia, and beef-juice, given 
both by the mouth and rectum, with artificial heat over the heart 
and extremities. The recumbent position should be maintained 
until the action of the heart is nearly normal. 

Narcotic Poisons. — Patient to be placed on side, head 
slightly raised ; cold affusion; heat to extremities; stimulating 
application to chest and back ; the use of stomach-pump. The 
antidote with tea, or coffee, or solution of acetate of ammonia. 



702 EMERGENCIES, AND THEIR TREATMENT. 

POISONS. 

Any matters which, when absorbed into the system, are capa- 
ble of destroying life, are termed a poison. Various terms are 
applied to poisons, according to their mode of action, as deadly, 
destructive, irritant, etc. 

Poisons are usually arranged, according to their action, into 
three classes — Irritant, Narcotic, and Narcotico-Irritant. 

I.— INORGANIC POISONS. 

Acids. — Nitric, Sulphuric, Muriatic, Oxalic, Carbolic, Fluoric 
Acids. 

Symptoms. — These acids, when swallowed, are strong corro- 
sive poisons. They give rise to a sour, acrid taste ; burning in 
the throat, which is increased by pressure, or swallowing, or 
coughing ; eructation, and excruciating pain in the stomach ; 
more or less puckering and excoriation about the mouth and 
parts touched with the acid. There- is usually vomiting, and 
the matters vomited effervesce with the carbonate of lime. 
Nitric acid causes yellow stains ; sulphuric, black ; carbolic, 
white. If enough of the acid has been swallowed to destroy 
life, there is a numbness all over ; countenance becomes glazed, 
extremities cold and clammy, followed by convulsions and death. 

Treatment. — Evacuate the stomach immediately with lobe- 
lia, or stomach-pump ; then any of the following remedies : 
Carbonate of.soda; calcined magnesia; or carbonate of magne- 
sia, freely in milk, or some mucilaginous drink. In the absence 
of these, whiting ; soap and water ; olive oil ; linseed tea ; gruel ; 
milk ; barley-water: In case of sulphuric acid, no water to be 
drunk, on account of the great heat evolved ; soap and milk 
are always handy. The external parts, when injured, to be 
bathed with soap and water, and then olive oil and lime-water. 

Prussic Acid. — Is a sedative poison, producing nausea, vom- 
ing, giddiness, debility, quick pulse, weight, pain in the head ; 
eructations having the flavor of the acid ; spasms, tetanus, con- 
tracted pupil, convulsions, death. 

Treatment. — No antidote known. Chlorine, and mixed 
oxides of iron, have been recommended, but their action is 
very doubtful. Cold effusion, electricity, stimulating frictions 
to chest and abdomen ; ammonia to nostrils, artificial respira- 
tion. After recovery from immediate effects, strong coffee or 
brandy ; sulphate of iron, in from five to ten-grain doses, is then 
thought well of. 

Nittro- Benzole, or artificial oil of bitter almonds, should be 
treated by strong coffee, brandy, ammonia, turpentine, ene- 
mata ; stimulation by friction, effusion, electricity, and animal 
charcoal. 



s 



AND THEIR TREATMENT. 763 

Alkalies and their Salts. — Ammonia, or Hartshorn; Mu- 
riate of Ammonia, etc: The overdose, or poisonous doses, of ammo 
nia and its salts, give rise to violent, caustic, acrid taste ; great 
heat in the throat, with destruction of the lining membrane ; 
difficult and painful swallowing; vomiting of bloody matter, 
which turns the yellow of turmeric brown ; intense, acute pain 
in the stomach ; cold sweats, weakness, hiccough ; violent, col- 
icky pains, with purging, bloody stools ; membranous flakes ; 
death. 

Treatment. — The vegetable acids, such as vinegar, lemon- 
juice, citric, and tartaric acid, in solution, are antidotes to the 
alkalies and their carbonates. The use of olive oil. or any other 
fixed oil, forms a soap with the free alkalies, and thus destroys 
their caustic effects. 

Caustic Potassse. — Potassa; Liquor Potassse; Strong Ley; 
Pearlash; Salts of Tartar ; Saltpetre; Liver of Sulphur ; Soda; Salts 
of Lemon: Causes general inflammation of the entire aliment- 
ary canal, hiccough, suppression of urine, vomiting, delirium, 
and death. In milder cases, violent burning in the stomach, 
vomiting, griping, and debility. 

Treatment. — Nitrate of potassa is neutralized by mucilagi- 
nous drinks, acidulated with vinegar or orange-juice ; liver of 
sulphur by a solution of common salt ; lemon-juice, citric acid 
are useful remedies to neutralize the other salts. 

Earths and their Compounds. — Baryta, in the form of 
a Carbonate, Muriate, Nitrate; Lime: Gives rise to irritation, 
inflammation of the stomach, vomiting, griping, diarrhoea, 
headache, convulsions, debility, and death. 

Treatment. — The sulphates of soda and magnesium are 
proper and effective remedies, and good antidotes to the salts 
of baryta. Phosphate of soda is also efficacious, as it converts 
the poison into an inert and insoluble form. Olive oil is excel- 
lent for lime. 

Gases. — Carbonic Acid Gas; Fixed Air; Carbonic Oxide; 
Fumes of Burning Charcoal ; Chlorine; Sulphuretted Hydrogen: 
Chlorine gas, if inhaled, causes great irritation of the lungs, 
cough, bloody expectoration, and confirmed congestion and 
inflammation. The carbonic acid gas, either from a charcoal- 
furnace or lime-kiln, is very soothing, producing asphyxia, 
spasm of the glottis, and apoplexy. Coal-gas and sulphuretted 
hydrogen, very similar. 

Treatment. — The antidote to chlorine gas is the cautious 
inhalation of ammonia : the lung symptoms to be treated same 
as pneumonia. For the other gases, massage; cold and warm 
effusions alternately; the cold dash ; friction ; artificial respir- 
ation ; electricity, positive pole to cervical portion of spine, 



764 EMERGENCIES, AND THEIR TREATMENT. 

negative to chest and diaphragm. The chlorinated liquor soda 
is a good antidote for sulphuretted hydrogen. 

Iodine. — Iodide of Potassium; Iodide of Sodium : Gives rise 
to burning pain in the throat ; lacerating pain in the stomach, 
and gagging, but inability to vomit; suffusion of the eyes; 
excessive pain and tenderness of the epigastrium. 

Treatment. — Encourage vomiting by copious doses of lobe- 
lia, in starch-water, and then administer starch freely, as it 
unites with the iodine, and forms an insoluble compound ; if 
there is no starch at hand, gruel or arrowroot. The free ad- 
ministration of starch is to be continued as long as blue iodide 
of starch is vomited. In iodide of potass, vomiting to be en- 
couraged by warm starch-water, and inflammation treated by 
the ordinary means. 

Metals. — Antimony; Tartar Emetic; Butter of Antimony; 
Oxide of Antimony : Nausea, vomiting, great irritation and pain 
in the stomach, accompanied by burning ; colicky pains in the 
bowels, with purging ; sense of tightness in the throat ; cramps, 
with persistent vomiting. 

Treatment. — Vomiting to be encouraged by copious drinks 
of warm milk or greasy soup ; an infusion of strong tea ; or any 
astringent, as galls, oak-bark, Peruvian bark, formica, tannate 
of antimony, which are inert, and make good antidotes. 

Arsenic. — White Arsenic; Arsenious Acid; Sulphuret of Arsenic; 
Fowler 's Solution ; Arsenical Paste ; Fly- Powder ; Arsenite of Copper, 
or Paris- Green; Arsenical Soap: Causes violent, burning pain 
in the region of the stomach and bowels ; tenderness, on pres- 
sure ; nausea, retching, vomiting ; great dryness and tightness 
in the throat ; hoarseness and difficulty of speech ; the vomited 
products are either greenish, or yellowish, or streaked with 
blood ; diarrhcea,with bearing- down ; kidneys and bladder often 
affected ; there is suppression of urine, severe burning in the 
entire urinary organs ; convulsions, cramps; clammy sweats; 
lividity of the extremities; countenance collapsed; eyes in- 
jected and sparkling ; delirium, and death. 

Treatment. — Emetics of lobelia ; vomiting to be encouraged 
by mucilagenous drinks, raw eggs in milk ; milk, eggs and lime- 
water ; followed by castor oil and charcoal, or calcined mag- 
nesia and animal charcoal, Hydrated sesquioxide of iron has 
been highly extolled ; if tried, give in large doses. If Fowler's 
solution has been taken, lime-water in milk is very efficacious. 
The best forms of mucilaginous teas are linseed, slippery elm. 
They should be freely given, and local stimulation over the 
stomach, so as to relieve pain and spasm; otherwise opium, 
conium, or henbane, to combat inflammatory action. 

Bismuth, Subnitrate, Nitrate, Carbonat,e Oxide ; Pearl-Powder ; 
Face-Powder ; all Cosmetics: Insidious and most common form of 



EMERGENCIES, AND THEIR TREATMENT. 765 

poisoning among ladies, giving rise to an irrepressible languor 
and debility. Symptoms and treatment same as the following. 

Copper, Sulphate of Copper, or Blue Vitriol; Acetate of Copper, or 
Verdigris; Arsenite of Copper; Food cooked in unused vessels, without 
being scoured ; or pickles made green by copper ; or tea (gunpowder 
variety), dried on copper plates ; spigots and copper bottoms in boilers 
of coal-oil cook-stoves : Cause symptoms of great irritation, and in- 
flammation of the entire alimentary canal, colicky, or griping 
pain, nausea, vomiting, hiccough, cramp, metallic taste in the 
mouth, suppression of urine, delirium, death. 

Treatment. — Vomiting to be encouraged by warm water 
and lobelia, milk and mucilaginous drinks. Combat inflam- 
matory symptoms with hot fomentations, enemata of milk; 
albumen, or white of egg, is the only antidote ; hence, raw eggs 
every little while, followed by milk. The other symptoms are 
to be treated upon general principles, as to whether they be 
inflammatory or nervous. 

Gold. — Chloride of Gold : Symptoms are very much the same 
as for copper, with the exception that the gold gives a pink 
stain to the flesh, and patches of that color can be detected 
about the mouth and inside of the lips. 

The salts of gold are decomposed by the sulphate of iron. 

Iron. — Sulphate of Iron, Cliloride of Iron : In poisoning by 
copperas, or green vitriol and tincture of iron there are all the 
symptoms of an irritant poison : colicky pains, constant vomit- 
ing and purging; severe pain in the throat; pain and full- 
ness about stomach ; collapse, as is exhibited in a cold skin, 
feeble pulse. 

Treatment, — Carbonate of soda is a reliable and efficient 
antidote, which should be freely given, with mucilaginous 
drinks; and particular symptoms relieved by general treatment. 

Lead. — Sugar of Lead ; White Lead; Litharge; Wines sweetened, 
or made more cooling by lead ; water drunk out of ivine casks; water 
in lead pipes, cisterns; food cooked in vessels glazed with lead; painters' 
operations in the making of White Lead; Oil-Cloth Printers: 
Causes general nervous depression and a cachexia with irrita- 
tion of the alimentary canal; blue line on gums, especially on 
the delicate nerves of the duodenum, irritating and causing 
contraction. Apt to be spasm. Nervous symptoms ; paralysis, 
partial or complete. If taken or operated in, violent and obsti- 
nate colic, rigidity and retraction of the abdominal muscles ; 
cramps; remission of pain ; obstinate constipation ; urine dimin- 
ished ; saliva increased ; countenance anxious and gloomy. If 
relief be not promptly obtained, giddiness, debility, torpor, 
coma, convulsions and death. When it causes paralysis it 
usually affects the upper extremities. 

Treatment. — Sulphate of magnesia and phosphate of soda 



766 EMERGENCIES, AND THEIR TREATMENT. 

are good antidotes for the soluble salts of lead. For the solid 
forms, a drink or beverage of dilute sulphuric acid in water. In 
the form of colic, enemata of lobelia, hot applications, anodynes 
and gentle laxatives, with chloroform to relieve cramp or spasm. 
In all forms of poisoning, when the urgent symptoms are re- 
lieved, iodide of potass in alternation, or with the chlorate of 
potass, are the only two remedies of any utility. The iodide 
unites with the lead in the body and eliminates it. 

Mercury. — Corrosive Sublimate ; Nitrate of Mercury ; White or 
Red Precipitate; or any Preparation of Mercury: Causes very 
violent symptoms of irritant poisoning ; harsh, metallic, astrin- 
gent taste in mouth ; burning pain at the pit of stomach ; vomit 
ing and purging, frequently bloody matter; tightness, and 
burning in throat occasionally, so great as to prevent speech ; 
often irritation of the urinary organs, with suppression of urine : 
countenance usually pale, but in some cases flushed ; great 
tendency to doze, stupor, with profuse salivation ; in other cases, 
convulsions, coma and death. 

Treatment. — Encourage vomiting with lobelia and demul- 
cent drinks ; white of several eggs promptly given, with milk; 
repeat; gargles of chlorate of potassa, or borax; meet inflam- 
matory symptoms with opium and other means. Baths of sul- 
phuret of potassium are useful for both lead and mercury. To 
unite with the mercury, and eliminate it from the body, no 
remedies excel iodide of potass, in alternation with the chlorate 
of potassa. 

Silver. — The Nitrate of Silver, or Lunar Caustic : Causes all the 
symptoms of a corrosive poison. In all cases, the best remedy 
is a solution of common salt, which immediately neutralizes 
and decomposes the caustic, and it has no further activity. Other 
symptoms to be treated on general principles. 

Tin. — Chloride of Tin ; Solution of Tin ; Oxide of Tin ; Culinary 
Utensils used for Cooking, especially Fats : Causes violent irritation 
of stomach and bowels, with griping and purging. The best 
remedy is albumen, to be given often and freely, followed by 
oil, and iodide and chlorate of potassa, as under Mercury. 
Since the introduction of petroleum cook-stoves, and canned 
food, tin-poisoning is common, especially from the cooking of 
soups or broths containing fatty matter, which has a great 
affinity for the tin. 

Zinc. — Oxide of Zinc ; White Vitriol ; Acetate of Zinc ; Chloride of 
Zinc : Causes very violent vomiting ; astringent taste ; burning 
pain in the stomach and bowels ; very pale face ; cold extremities ; 
dull, glassy eyes ; intermitting pulse. It seldom causes death, 
owing to the fact that it is a good emetic. 

Treatment, — The vomiting is to be relieved by copious 
draughts of tepid water, with carbonate of soda, which decom- 



EMERGENCIES, AND THEIR TREATMENT. 767 

poses the sulphate of zinc. Milk and albumen act as antidote?, 
followed by preparations of tannin. Otherwise, general prin- 
ciples are to be observed. 

Phosphorus. — Infusion of the Sticks; Phosphorus- Water ; Phos- 
phorus in Fat or Oil; Phosphoric Acid, etc. : Causes all the symp- 
toms, in even slightly large doses, of acute inflammation of the 
stomach — vomiting, raw-beef tongue, tenderness, tympanitis, 
peritonitis, and death. The burning in stomach is intense. 

Treatment. — If vomiting is not present, give an emetic ; fol- 
low with linseed tea or slippery elm infusion, with magnesia in 
suspension ; and repeat. Treat symptoms on general principles. 

Glass, Enamel, Pins, and Other Foreign Bodies, are apt to cause 
irritation of the bowels. White of egg and solid diet. 

II.— ORGANIC POISONS. 

Vegetable poisons embrace a large and often obscure class, 
for which there is no universal antidote known ; hence, the 
treatment varies with nature of the substance taken. If possi- 
ble, the poison should be discharged from the system, either by 
emetics, stomach-pump, or otherwise. In selecting an antidote, 
it must be one that does not poison itself, if possible, and admits 
of being given in large doses without danger. Its action should 
be quick; capable of combining with the poison, and depriving 
it of its deletorious properties, irrespective of the gastric juice ; 
and should produce a harmless chemical combination and 
insoluble compound, and prevent absorption. Purified animal 
charcoal has the power of combining with all the poisonous 
principles of animal and vegetable substances, and produces 
innocent compounds. It has not such a reliable effect in the 
case of mineral poisons ; but as a general antidote for vegetable 
and animal poisons, it cannot be too highly extolled. 

Vegetable Acids. — Acetic, Citric, Tartaric, Oxalic Acids, and 
Vinegar : Cause a sour, acrid taste ; burning in throat, increased 
by pressure, swallowing, coughing ; with pain and tenderness 
over stomach ; all the symptoms of gastritis. 

For acetic, citric, and tartaric acids, and vinegar, the carbon- 
ate of soda, potassa, lime, magnesia, are good antidotes. 

For oxalic acid, the carbonate of lime or magnesia can be 
used. 

Oil of Bitter Almonds. — Laurel- Water : This is liable to be 
converted into prussic acid on the stomach. 

Ammonia is an antidote ; chlorine and mixed oxides of iron, 
if handy; cold affusion; friction to chest and abdomen; vom- 
iting, if possible, followed by brandy and coffee. 

Alochol. — Brandy, Whisky, Wines, all Spirituous Liquors : In- 
toxication, coma, or complete insensibility, with apoplexy, or 
paralysis of one side; face swollen, of a dark, livid color; the 



768 EMERGENCIES, AND THEIR TREATMENT. 

breathing labored and stertorous, with a peculiar puffing out 
of the lips ; the breath either smells of the liquor or chloroform, 
which will distinguish it from apoplexy. 

Treatment. — A powerful, rousing emetic, with a copious 
solution of the acetate of ammonia, well diluted. The mixture 
of lobelia, capsicum, and valerian is the best. If there is no 
acetate of ammonia around, give carbonate of soda freely; 
enemata of the ammonia per rectum. Keep patient erect; 
use the cold and warm douche alternately on head and chest. 
If there is coldness of extremities, warmth, friction, mustard to 
extremities, and over heart ; electricity, artificial respiration. 

Volatile Oil. — Ether ; Chloral ; Chloroform ; Creosote ; Oil of 
Tar; Oil of Turpentine; Fusel Oil; Oil of Tobacco; Nitrite Amyl: 
Cause burning pains in the stomach, vomiting, pungent taste, 
purging, and griping. The oil of turpentine and tobacco affect 
the nervous system. The peculiar odor of each oil is manifest 
on the breath and matters vomited. 

Treatment. — Chloroform and ether will require powerful 
lobelia emetics, with copious drinks of starch-water ; creosote 
is immediately rendered inert by white of egg. There is no 
general antidote for the other oils. Cases to be managed on 
general principles. 

Irritant Vegetable Poisons, — Oroton Oil; Indian Turnip; 
Mandrake; Colocynth; Sabina ; Poke Root; Castor Oil; Oil of 
Tansy; and many others of this class. Here is a class of drugs 
very common in domestic practice, that never should be admin- 
istered alone, neither in small nor large doses, as they are irri- 
tating poisons, and cause an acrid secretion from the liver. 
They should always be combined with some other drug to 
modify their action, as croton oil and castor oil, with glycerine ; 
mandrake, colocynth, with hyoscyamus; sabina, with borax, etc. 

If this is not observed, the effects of this class of vegetable 
poisons will be an acrid, pungent taste, with more or less bitter- 
ness ; excessive heat, with thirst ; great dryness of the mouth 
and throat, with sense of tightness; retching, and persistent 
vomiting, which is continued after the stomach is emptied : 
purging, griping, with twisting pain in both stomach and 
bowels ; pulse at first may be strong, frequent, and regular, but 
soon becomes weak and intermittent; breathing quick and diffi- 
cult; pupils dilate, and become insensible to light; cold, clammy 
sweats, and death. 

The same class of remedies, if applied to the skin, cause 
erythema, vesication, pustules. 

Treatment. — If vomiting has taken place by the drug or 
poison, and efforts are still being made, administer very copious 
drinks of tepid water, with bicarbonate potassa, or cream of tartar 
lemonade, warm. If vomiting has not taken place, then let the 



EMERGENCIES, ANJ THEIR TREATMENT. 769 

patient drink freely of tepid water, with bicarbonate of potassa, 
and evacuate the bowels with repeated enemata. Afterwards 
try, first, grain doses of hyoscyamus extract, in trituration with 
strong coffee, and repeat; if that fail, try solid camphor, with 
toast-water, and repeat ; a piece of camphor, size of pea or bean, 
in some soft substance, to swallow ; or try the hyoscyamus and 
camphor in alternation ; mustard over stomach, bowels, liver, 
and to extremities, or else friction ; try camphor- water and 
hyoscyamus in enemata. Treatment of other symptoms on 
general principles. 

Narcotic Poisons, and Aero-Narcotic Poisons. — Aconite ; 
Veratrum Viride; Belladonna; Poison Hemlock; Stramonium; 
Digitalis; Hyoscyamus; Tobacco; Nux Vomica or Strychnine; 
Opium or Morphia; Rhus 7hx. } etc.; Ergot; White Hellebore; 
Calabar Bean : Cause the following effects, if given or taken in 
poisonous doses : Stupor, numbness, heaviness in the head ; 
desire to vomit, which is slight at first, but afterwards becomes 
insupportable; a kind of intoxication, or stupid manner, or 
aspect ; pupils either dilated or contracted ; delirium, with furi- 
ous, or otherwise, contortions of body; pain, convulsions, or 
spasm of limbs, or complete palsy; pulse is variable, quick, 
intermitting; strong, feeble, or imperceptible; the breathing is 
hurried, slow, labored, with pauses, anxiety, and dejection; or, 
if asleep, coma, stertorous breathing, death. 

General Treatment for all. — Evacuate the stomach, if pos- 
sible, by mustard or lobelia, till the full effect is produced. If 
these two remedies fail, tickle the fauces with a feather. If 
there is great drowsiness, bordering on insensibility or apoplexy, 
keep patient in motion, and beat him with willow rods covered 
with wet cloth; if heat is deficient, warmth, and friction with 
energy. It is best not to give much drink until the poison is 
vomited, as they tend to dilute the poison and render it easier 
of absorption. After the poison has been removed, strong coffee 
should be given every fifteen minutes, with a few drops of aro- 
matic spirits of ammonia. A little vinegar in alternation is 
good. Electricity, positive pole to neck, face, and negative pole 
to the diaphragm, so as to sustain the respiration, if feeble. If 
there are convulsions, contortions, or spasms, use chloroform by 
inhalation. 

Special Treatment for Narcotics, Aero-Narcotics, Opium, 
or Morphia. — If the patient is unable to swallow the emetic, 
enemata belladonna is often successful as an antidote, in from 
thirty to sixty-drop doses. Tannic acid in simple syrup is said 
to be useful. Persist with the strong coffee till pupil dilates 
and skin loses its pallor, and the flagellations with the rods or 
wet towels. If there is no good coffee handy give alcohol. 

Veratrum Viride, — Large doses of tincture of opium every 

61 



770 EMERGENCIES, AND THEIR TREATMENT. 

hour, say from thirty to sixty drops, with animal charcoal be- 
tween. 

Belladonna. — Same as Opium. Administer a solution of 
sulphate of morphia freely, and animal charcoal. 

Aconite. — Animal charcoal ; castor oil ; strong coffee ; with 
aromatic spirits of ammonia; movement ; friction; beating with 
wet towels; enemata, and artificial respiration. 

Nux Vomica ; Strichnine and Brucia. — Emetics ; enemata ; 
olive oil ; animal charcoal. Warmth and sweating to be in- 
duced ; chloral and bromide of potass in immense doses, in 
camphor water, with movement, and other precautions. 

Calabar Bean. — Emetics ; animal charcoal, and belladonna. 

Digitalis. — Gelseminum ; emetics ; castor oil ; infusions con- 
taining tannin, as strong tea, oak bark, strong coffee or brandy. 

Nicotine, or Tobacco. — Vinegar in sweetened water, or tan- 
nic acid in sweetened water. 

Ergot. — Emetic ; belladonna and carbonate of soda, freely ; 
animal charcoal. 

Petroleum. — Oily and mucilaginous drinks frequently. 

Stramonium. — Emetics ; morphia and animal charcoal. 

Henbane. — Emetics; morphia; castor oil; animal charcoal. 

Nitro-Benzole ; Analine. — Strong coffee; brandy; am- 
monia; turpentine; enemata; animal charcoal. 

Poisonous Mushrooms ; Bologna, and Other Sausages. — 
Causes nausea, pain, heat in stomach and bowels, with grip- 
ing, purging ; great thirst, faintness, convulsions, dilated pupil 
and prostration, with cold, clammy sweats. 

For which lobelia emetics, and large doses of Epsom salts, 
to cleanse out bowels, with stimulants and tincture of opium, 
and animal charcoal. 

Decayed meat, putrid flesh, or other agents loaded with bac- 
teria, managed on- general principles by emetics, cathartics and 
animal charcoal, with diffusible stimulants, to overcome pros 
tration. 

III.— ANIMAL POISONS. 

Poisonous Fish. — Land Grab, Yellow-Billed Sprat, Gray Snap- 
per, Conger Eel, Bottle Fish, Spanish Mackerel, King Fish : Causes, 
if cooked and eaten, uneasiness, pain in stomach, with nau- 
sea, vomiting, vertigo, headache, heat in eyes, thirst, and various 
forms of eruption on the skin, with prostration and death. 

Treatment. — An emetic of lobelia, followed with an active 
cathartic, so as to have frequent evacuations of the bowels. Vine- 
gar and water should be freely drunk after the above remedies 
have operated, and the body sponged with the same. A solu- 
tion of chlorate of potassa3 is the best antidote to the poison. 
General treatment as to symptoms present. 



EMERGENCIES, AKD THEIR TREATMENT. 771 

Poisonous Serpents. — Boa, Copperhead, Horned Viper, Viper, 
Black Viper, Rattlesnake, Water Viper: Causes sharp pain in the 
wounded part, which soon extends up the limb to body ; great 
swelling; at first, hard and pale ; then reddish, livid, gangren- 
ous. Fainting, convulsions, vomiting, jaundice ; pulse small, 
frequent, irregular ; constriction of the chest, causing difficult 
breathing, prostration, sweats, failure of the intellectual facul- 
ties, convulsions or paralysis, death. 

Treatment. — Wound treated by ligation, suction, free bleed- 
ing, then by applications of muriate ammonia, and starch 
(grated potatoes,) and internally, brandy and carbonate of am- 
monia to intoxication. 

Spanish Flies. — Potato Fly ; Causes nauseous odor of the 
breath, acrid taste ; burning heat in throat, stomach and abdo- 
men ; frequent vomiting, greenish, coffee grounds, or bloody ; 
copious black stools, with pure blood ; very great pain in the 
stomach; painful and obstinate priapism, with heat in bladder, 
stranguary, retention of urine, terrible convulsions, delirium, 
and death. 

Treatment. — Encourage vomiting by drinking sweet-oil or 
glycerine, or sugar and water, or milk, or linseed tea. Same 
remedies by enemata, Combat symptoms of inflammation of 
kidneys and bladder. Dissolve camphor in oil, and rub into 
arms and legs. 

Venomous Insects. — Wasps, Hornets, Bees, Gnats, Gadflys, 
Mosquitoes, Bugs : As a general rule the sting of these insects 
produces local inflammation ; in some cases they give rise to 
sickness and fever. 

Muriate of ammonia, in saturated solution, or spirits of harts- 
horn on a piece of rag, is sufficient to antidote and relieve the 
burning, tingling in the skin. 

Sumach, Ivy, Poisoned Vines, are at once neutralized by the 
same remedies. 

Post-Mortem, — Poison introduced by the bacteria of dead 
bodies in dissection, through scratches, abrasions, cuts; is best 
neutralized by thorough washing, and the local application of 
permanganate of potassa. 

Rabies. — See Hydrophobia. 

Woorara Poison. — Iodine with starch and iodide of potass, 
neutralize the action of this poison. 

Death Causes. — There can be no life maintained without the 
circulation of arterial blood. If no blood circulate through the 
arteries, as in rupture of the heart, or in perforation of its sep- 
tum, the result is death. Death by a stoppage of the circulation 
of the blood may be of two kinds : 

(1.) Death by anaemia, in which there is a want of due sup- 



772 EMERGENCIES, AND THEIR TREATMENT. 

ply of blood to the heart. The anaemia may be due to a loss 
of blood, or its impoverishment by disease, or drugs. 

(2.) Death by asthenia, when there is a failure in the con- 
tractile power of the heart. This may arise from disease of the 
cardiac walls, or valves ; or from the arrest of the heart's action ; 
or through the nervous system, as inapoplexy ; disease of the 
medulla oblongata, shock, or certain poisons. When either 
from anaemia or asthenia, the death is sudden ; it is said to be 
dae to syncope, or sudden prostration of strength. Sometimes 
vital force fails partly from anaemia and partly from asthenia ; 
as in cases of starvation, phthisis. 

Death by circulation of venous blood may happen in one of 
two ways : 

(1.) Apnoea, or asphyxia, or suffocation, when access of air to 
the lungs is stopped ; as in drowning, strangulation, laryngeal 
and lung diseases ; tetanus, section of phrenic and intercostal 
nerves. 

(2.) By coma, or deep sleep ; in which muscular movements 
required by respiration, cease, owing to insensibility produced 
by cerebral disease. 

In apnoea there are successively impeded respirations, circu- 
lation of venous blood, and insensibility. In coma, the order 
is reversed : insensibility, cessation of thoracic movements, and 
stoppage of chemical function of lungs. 

RIGOR MORTIS. 

Cadaveric rigidity is due to a chemical process — a process of 
death, characterized by a coagulation of the myosine, and may 
be considered the death of the muscles. When the coagulation 
takes place, the acids, which are being constantly formed, and 
as continuously removed during life, accumulate in the muscle 
and gradually effect a solution of the myosine, and then the 
azotized matters undergo decomposition and develop ammonia, 
which in its turn dissolves the myosine, and thus occasions the 
disappearance of the rigor. 

In this process, when rapid, great heat is often evolved, espe- 
cially when the rigor is being established ; the rigid muscle 
slightly diminishes in volume. The disease of which the pa- 
tient died has an influence on the quick appearance of the rigor, 
its duration, etc. ; so has heat and cold. 

Following that the body returns to its natural earths or gases, 
all except the cadaveric alkaloids, which remain as permanent 
salts, and are not destroyed even by cremation. 

The amount of indistructible cadaveric alkaloids present in an 
ordinary sized human being, varies from six to eight grains, 
depending greatly upon the development of his intellectual 
capacity or powers. 



REMEDIAL AGENTS. //O 



REMEDIAL AGENTS. 



When searching for any Prescription or Remedy, always 
refer to both CONTENTS and INDEX, noting the directions 
carefully. Copy, verbatim et literatim, word for word and 
letter for letter, and hand it to the druggist 

The prescriptions are classified under appropriate head- 
ings; when no special formula is indicated, only the general 
head mentioned, as " Alterative," " Tonic," etc., then read 
them all over and select that or those most suitable to the 
case. As one prescription is mentioned very many times, 
this arrangement is designed to prevent repetition. 

In the present work we have enumerated a few of our best 
arid most reliable remedies, and given the prescription in plain 
language, so that it can be understood by the ordinary scholar. 
The dose that has been laid down, when not otherwise stated, 
is for an adult male ; and the father or mother in prescribing 
them for the sick must exercise care, a good deal of tact, and 
great judgment, and attend to age, sex, temperament, nature 
of disease, climate, etc., etc. 

As the operation of drugs is greatly influenced by the form 
in which they are given, we have almost invariably put them 
up in trituration, or diluted form, and have them taken in 
water. The purity of the remedy, and the mode in which it 
has been prepared originally and by a reliable firm, the time of 
day at which it is given, the dose, the condition of the stomache, 
as regards the presence or absence of food, and age of the pa- 
tient, all must be looked to. The full dose, as we have laid 
down, is for the adult man, between twenty-five to sixty-five 
years of age. 



774 REMEDIAL AGENTS. 

Now, a good way to regulate the dose for younger or older 
persons is as follows: Suppose the dose laid down is thirty 
grains, or thirty drops, for a standard. 

Suppose the patient is under, or about, twenty years of age, 
the dose should be twenty grains, or drops. 

Fourteen years of age, ten grains, or drops. 

Seven " seven and a half grains, or drops. 

One to two " " two grains, or drops. 

Over sixty-five, the dose should decrease in the same manner. 
Women, on account of their delicate organization, great sensi- 
tiveness, extreme impressibility, should have doses somewhat 
smaller than males. .' 

If possible, discontinue all drugs during menstruation, preg- 
nancy, lactation, unless it be some simple tonic — unless some 
special indication exists. There is a good knack in striking 
the right dose, proper adaptation of the remedy to meet the 
indications of the disease. In some conditions, as in delirium 
tremens, epilepsy, puerperal convulsions, we are unable to intro- 
duce the remedy into the stomach, and then we use the skin, 
cellular tissue, rectum. If in the cellular tissue, it should be 
a pure alkaloid, in solution, in a little smaller doses. This form 
of medication should never be used on children. 

Some patients have a peculiar idiosyncrasy to some drugs ; 
and this in some cases extends, not only to medicines, but to 
odors and different kinds of food ; and when this is the case, 
the medicine or food should not be given. 

No case of disease should be given up; for if it does not 
admit of. cure, it can at least be ameliorated, or its severity 
mitigated. True, some diseases are incurable, and the patient 
should not be deceived by any false promises ; still, recoveries 
take place under the most unfavorable circumstances. 

Families who possess this work should discard all patent 
medicines, as they have better prescriptions than any in exist- 
ence. The most trivial sickness should never be overlooked ; 
let it be attended to at once. Hope and confidence are neither 
mean nor insignificant remedies; and in what is termed the 
Expectant, or Nihilistic, system of practice, faith and sugar is 
all the patient has for his money. 

In no case should drugs be prescribed without regulating the 
character of diet, clothing, and recommending bathing, rest, 
sleep, ventilation, light, cleanliness, and enforcing the admin- 
istration of food at stated intervals. No cooking of food near 
the sick; nor should food, such as milk, beef-tea, be kept in the 
sick-room. 

There should be no crowds of people, or noise, but the greatest 
quietness and rest. If it is some contagious fever, there should, 
if possible, be two beds in the apartment — one to be used during 



REMEDIAL AGENTS. 775 

the day, the other at night; bedclothes and body-linen changed 
frequently. Every precaution should be taken to prevent the 
dissemination of the diseased germs, by the use of antiseptics 
in the apartment, such as solutions of permanganate of potassa 
and sulphate of iron; and by prohibiting egress and ingress of 
all persons except the nurse or attendants. 

For the sake of convenience, we have arranged the various 
prescriptions under the following heads : 

Alimentation, Enemata, 

Acupuncturation, Fomentations, 

Alteratives, Gargles, 

Anaesthetics, Hypodermic Injections, 

Anodynes, Inhalations, 

Antacids, Inunction, 

Antispasmodics, Liniments and Ointments, 

Anaphrodisiacs, Massage, 

Aphrodisiacs, Mineral Water Baths, 

Antiseptics, Ozonized Remedies, 

Arterial Sedatives, Paraffine Splints, 

Astringents, Pessaries or Pastil es, 

Baths, Plasters, 

Caustics, Poultices, 

Cough Remedies, Preservation of Teeth, 

Diaphoretics, Purgatives, 

Diffusible Stimulants, Reflex Sedatives, 

Diuretics, Suppositories, 

Electricity, Tonics, 

Emetics, Uterine Remedies, 

Ernmenagogues, Vermifuge Remedies, 
Climate for Invalids. 

Our readers will perceive, after scanning the list of remedies 
here and in the body of the work, that we almost inavriably 
prascribe the medicinal herbs of the United States, as the best 
adapted for the cure of our diseases, being superior in their 
efficacy to the mineral poisons used by a certain class. We have 
a very exalted opinion of this class of remedies, and have rarely 
recommended mineral medicines, such as arsenic, antimony, 
mercury, etc., which, when taken into the system, lurks there 
for years, and it is doubtful if they are ever eradicated. 

The prescriptions are classified, as far as practicable, under 
the headings to which they belong. Some of them are appli- 
cable to numerous diseases, but are inserted to avoid repitition 
under one head only. The best plan in all cases to find a 
recipe, is to consult both contents and index. 

In the compilation of these prescriptions, especial pains have 
been taken to economize space as much as possible without 



776 REMEDIAL AGENTS. 

impairing their clearness for ready reference in the family. 
With this end in view, we name the combination, and, after 
giving the formulae, enumerate the principal diseases in which 
it is proper to use it. 

ALIMENTATION, OR NOURISHMENT. 

Consists in providing a suitable diet for the sick — a form of 
liquid nutrition, easily digested, rich in blood-forming elements; 
one that can be given every one or two hours, and that will not 
require much effort on the part of the stomach, pancreas, bow- 
els, and lymphatics, to be converted speedily into blood. Milk 
and beef tea or extract are the best. 

Milk and Lime-Water. 

Good, fresh milk, about a large tumblerful, or eight ounces ; 
lime-water, one teaspoonful ; mix. Let patient drink half or 
more, as indicated, but at regular stated intervals. The addi- 
tion of the lime-water to the milk is to prevent the casein of the 
milk from coagulating on the stomach, so as to render it easy 
of digestion. Five grains of bicarbonate of potassa can be used 
instead of the teaspoonful of lime-water, with same or even bet- 
ter results. Milk warm from the cow is the best, or it can be 
warmed or boiled, in cases of diarrhoea, with a handful of cin- 
namon sticks in it, and then the lime-water or bicarbonate of 
potassa added as used. 

In all cases milk must be kept carefully covered, never ex- 
posed to the air, nor kept in the sick room, and above all things, 
be fresh. It is unquestionably the best diet for the sick. 

Beef Tea. 

Chop one pound of lean beef very fine, like mince-meat ; 
cover with one pint of cold water ; place in a close vessel, and 
boil for nearly an hour ; then take oft the scum, cool, and strain ; 
season to the taste. Very nourishing and palatable drink, and 
quickly made. 

Extract of Beef. 

Take one pound of lean beef, free from fat, skin, bone ; chop 
it up fine, as mince-meat ; just barely cover it with water ; then 
place it in an hermetically sealed glass jar ; put a saucer in the 
bottom of a pot, then place in it the jar with the meat ; fill 
with water, so that the water will reach halfway up the jar; 
then put the pot on the fire, and let it boil four or five hours, 
or even longer ; when nearly cold, strain through a coarse sieve ; 
season with salt to suit the taste There should be about six or 
seven ounces of extract. Extremely efficacious in great debility, 
hemorrhages, exhaustion, fevers. 



REMEDIAL AGENTS. 777 

Instantaneous Beef Tea. 

Take a pound of lean beef, chopped very fine ; then take a 
pint of water, rendered sour or tart with muriatic acid, palat- 
able for drinking, and add it to the meat, in a china bowl ; stir 
repeatedly, or crush it well ; pour through a hair sieve, and 
back again into the bowl, until all the fibrin is taken out of the 
meat. It makes a most acceptable drink, highly nutritious, 
and is very suitable when in great haste, and is, perhaps, the 
best method of extracting the blood-forming elements of the 
meat. Season, as usual, to the taste. 

Raw-Meat Juice, 

Chop lean beef fine as mince-meat ; pound it in a mortar, 
and add water to an amount not exceeding the volume of the 
meat; then mix and pound thoroughly, and latterly strain off 
by compression through muslin, or fine linen, or a sieve; sea- 
son to suit. Juice of raw meat is of great utility in cholera infantum, 
wasting , or when the stomach has lost its tone. 

Chicken Extract. 

Cut a chicken into small pieces, chop bones and also gizzard ; 
put the whole into a fruit-jar, and cover with cold water; then 
hermetically seal it up, so that it will be tight; set the jar in a 
pot, with a saucer at the bottom ; fill it up with water till it 
reaches half way ud ; then place on fire and boil for three or 
four hours ; then strain the contents of the fruit-jar ; skim care- 
fully off all fat; season it slightly with salt, pepper, mace, or 
loaf-sugar and lemon, according to the condition of the patient 
for whom it is intended. Excellent for a change, but must not 
supersede the beef extracts. 

Mutton Broth. 

Take one pound and a half of lean mutton-chops off the leg ; 
broil them carefully and well, but do not burn them ; then put 
them into one quart of water ; season with a little salt, some 
parsley, mace; boil slowly for four hours; skim off any fat. 
Vegetables, barley, rice can be added, if desired, or the broth 
can be thickened by grating the kernel of boiled flour, as much 
as is necessary to render it very agreeable ; season as desired. 

Mutton Soup, Beef Tea, Extracts, etc. 

Take of mutton or beef, one pound and a half; cold water, 
one quart ; a little salt, some parsley, and two ounces of rice. 
Simmer for four hours ; boil for five minutes ; strain and serve. 

Another good way to get good beef tea is to mince a pound 
of meat very fine ; put it into a common earthen tea-pot (not 
tin or metal), and add one pint and a half of cold water ; put 



778 REMEDIAL AGENTS. 

on the lid, and set the pot on the stove or range over night, 
close enough so as to give about a pint of beef-tea. 

Beef tea, broths and soups, made from preserved meats are not 
to be used for the sick in their homes. They may answer well 
on board of ship, and in out of the way stations, and may be 
very palatable to the taste, but they are not nutritious, and can 
never supersede fresh meat. It is unnecessary here to speak of 
their deleterious compounds, their composition being mainly 
gelatine, upon which human tissues starve. 

Milk-Food. 

The milk-food of the Anglo-Swiss condensed milk company, 
of Cham, Switzerland, is scientifically, theoretically, and prac- 
tically, the best nourishment for children, well or ill — it cannot 
be surpassed, as it satisfies all demands. It is made of the 
best milk and wheaten phosphates, with a little cane sugar and 
a normal amount of saline matter. The preparation is of im- 
mense value for nutrition in general, and most appropriate for 
invalids and children. 

To each teaspoonful of milk-food add four or five ounces of 
water. Mix the powder first to a smooth paste with a little of 
the water ; then add the rest, and boil for five minutes, stirring 
it constantly, after which it is ready for use. Use fresh, neither 
cold nor hot, and not too much at a time. Keep the utensils 
scrupulously clean. * It excels in nutritive properties ; pleasant to 
taste, and highly blood-forming. 

Boiled Flour. 

For the purpose of thickening beef tea, or extract; mutton, 
or chicken broth, the following is excellent, as it contains chiefly 
the wheaten phosphates. Take a pound of flour ; tie it up in 
a towel, and dip it a few times into cold water, so as to dredge 
the outside into a crust. Then drop it into a pot of boiling 
water, and let it boil actively for six or more hours. Remove 
it from the water, and allow it to cool ; then trim off the out- 
side doughy rind, and save the hard central portion, or kernel, 
which is to be grated in quantities desired for thickening. 
Highly nutritious. 

Arrowroot. 

Mix three tablespoonfuls of arrowroot in a teacupful of water 
until quite smooth ; cover it, and let it stand a quarter of an 
hour : meantime bring to a boiling point half a pint of milk, 
and while boiling sweeten with sugar, and add the arrowroot, 
and let it boil nearly five minutes, keeping constantly stirring. 
Remove and flavor with lemon essence and grated nutmeg, to 
the taste. It may be made entirely of milk. 



REMEDIAL AGENTS. 779 

Tapioca. 

Soak a sufficient quantity over night in water ; then boil it 
gently, either in milk or water, till quite clear, and add lemon- 
juice, or essence; wine, sugar, and cinnamon, as desired. 

Brandy and Egg Mixture, 

Take the whites and yolks of four eggs ; beat them up in^ 
four ounces of water. After well beaten into a homogenous 
mass, add three ounces of brandy, with some sugar and nutmeg 
to suit. In cases of great debility, or prostration, it can be given 
frequently, to keep up tlie strength, in doses of two or three tablespoon- 
fuls. 

Take a tablespoonful of fresh cream, and beat it up thor- 
oughly with a new laid egg ; add to this some white sugar and 
a tablespoonful of brandy. Give as often as indicated. 

Gruel, 

Take two or three tablespoonfuls of oatmeal ; add to it four 
of cold water, and mix them thoroughly together. Then add 
a pint of strong beef tea, boiling, or of milk. Boil all together 
for five minutes; keep constantly stirred to prevent burning ; 
then strain through a sieve. An excellent, simple restorative dur- 
ing convalescence from acute disease. 

Or the three tablespoonfuls of oatmeal can be added to one 
pint of boiling water, and boiled twenty minutes, and one table- 
spoonful of fresh butter, one of sugar, one of cream of tartar 
added, with salt and nutmeg to suit. Excellent, nutritious drink. 

Rennet Whey. 

Take a piece of dried rennet, about two inches square ; chip 
up into small pieces, put in a tea-cup half full of water, and let 
stand all night, and in the morning stir this rennet-water into 
a quart of warm milk. Cover it and set it near the fire, till a 
firm curd is formed. Pour off the whey, and use as a drink, 
Avhich is cooling, palatable and appetizing. Of great utility when 
the stomach has lost its tone. 

Lemonade. 

Take four ounces of lemon-juice ; four ounces of sugar; half 
an ounce of lemon-peel ; and three pints of boili.ng water. Let 
them stand till cold. In fevers a little sweet spirits of nitre may be 
added. 

Toast-Water. 

Toast several slices of bread (not burnt) ; place them in a pit- 
cher, and cover with boiling water and cool strain. Cracker- 
water in same manner. 

Rice- Water ; Barley-Water, 

Take two ounces of rice, or barley ; add to one or two quarts 



780 REMEDIAL AGENTS. 

of water. Boil slowly till it is reduced nearly a half. Season 
to suit, with salt, nutmeg, lemon-peel. 

Wine Whey. 

To half a pint of boiling milk add two tablespoonfuls of 
sherry wine. Cover and let it cool, and strain through a piece 
of muslin. Sweeten with sugar. 

Iceland Moss ; Irish Moss. 

Take an ounce of each ; boil slowly in a pint and a half of 
milk, for three quarters of an hour; strain through muslin; 
add three ounces of fine white sugar, or more, if desired. Ex- 
cellent in cough. Taking a little now and again. 

Demulcent Drinks 

Are made of linseed boiled in water ; lemon and sugar added 
to suit, and strained ; gum-arabic in boiled water ; slippery elm 
water ; infusion of marshmallow ; isinglass, boiled in milk with 
half a dozen of crushed almonds ; infusion of tamarinds. 

Solid Food. 

As soon as recovery takes place, solid food should be recom- 
mended, such as buttered toast, biscuit, broiled tenderloin, or 
chops, broiled chicken, roasted potatoes, vegetables, and ripe 
fruit; drinking at meals to be avoided. Gradually the solid 
diet to be more varied, by the addition of soft boiled eggs, boiled 
white-fish. Tea and coffee are of little account ; still, if the 
patient desires them, they need not be withheld. 

If it is desirable to administer ale or porter, let them be taken 
with a good broiled beef-steak; and so with wine. 

Diastase, Pepsin, and Pancreatine. 

The starchy food is digested in the mouth by the diastase of 
the saliva ; and if there is no saliva, it passes into the stomach, 
whose juices never digest starch. By and by it moves on into 
the duodenum, where it is digested by the secretion from the 
pancrease; if there is no pancreatic secretion, it will pass 
along the bowels undigested, and is evacuated. 

Patients with feeble digestive power make a slow recovery, 
unless the digestive juices are added to aid the elaboration of 
the food. Malt extracts supply the place of diastase in the saliva ; 
pepsin the gastric juices, and pancreatine for the natural secre- 
tion from the pancreas to emulsify the fatty constituents, and 
act upon the undigested starch. Disease, or obstruction of the 
pancreas, is rare ; still, it is occasionly met with in degenera- 
tion of the gland, when free fat is found in the stools, and its 
place can be readily supplied artificially until the difficulty is 
removed. 

There are several preparations of pancreatine in the market, 



REMEDIAL AGENTS. 781 

all tolerably good, and no one in particular can be mentioned 
as the best. 

The Use of Malt Extracts. 

As the preparations of malt are now very much used and 
recommended by the profession, the public should know what 
they are, and what purposes they serve. 

Malt is barley which has been made to germinate by moisture 
and warmth, and afterwards dried, by which the vitality of the 
.seed has been destroyed. By this process, part of the protein 
matter of the barley is converted into diastase. This only con- 
stitutes one five-hundredth part of the malt, but serves to con- 
vert about forty per cent, of the starch of the seed into grape- 
sugar, or gum — dextrine. The seed of barley contains, then, a 
quantity of diastase, which, in the act of germination, is con- 
verted into dextrine and sugar, for the nutrition of the embryo 
plant until it can feed itself. The parent seed, or grain, stores 
up food for its offspring in the form of insoluble starch ; and 
along with it a ferment, which transforms insoluble starch into 
soluble sugar, for the use of the plant in the act of germination. 
How the maltster found it out is not known. When the physi- 
ological chemist found that starch was transformed into dextrine 
and sugar by diastase in human saliva, the step forward was an 
easy one. 

The starch of our food is converted by the ferment of our 
saliva into sugar, or a soluble matter half-way between starch 
and sugar, known as dextrine. Starch, as starch, is insoluble, 
and requires to be rendered soluble in the digestive act, in order 
that it may pass from the alimentary canal into the blood. 
The ferment of the saliva is known as diastase. By its action a 
great portion of the starch of our food is digested, or made 
soluble. Whatever starch is not digested by the salivary dias- 
tase, undergoes no change in the stomach, but passes on to the 
duodenum, and is there acted on by the diastase of the pan- 
creas. Diastase is either salivary or pancreatic, and is only active 
in an alkaline medium ; invariably killed by an acid. Con- 
sequently the digestive act of the stomach, when there is a tidal 
current of all the acids of the body to that organ, it does not 
affect the digestion of starch. When the salivary diastase is 
brought into contact with starch in the mouth, the transforma- 
tion commences. The starch so rendered soluble, easily passes 
through the stomach, and does not impede or interfere with 
digestion in the stomach. But when the salivary diastase is 
imperfect, then a quantity of undigested starch harasses, and 
hampers, or retards the digestive act in the stomach. In such 
cases it is desirable to improve the digestion of starch by this 
artificial agent — extract of malt. 



782 REMEDIAL AGENTS. 

To utilize the digestive ferment of the embryo plant for the 
necessities of the human family, is a step forward in the treat- 
ment of defective nutrition. But certain cautions must be 
observed in such use of vegetable diastase, else it is rendered 
inoperative and useless ; it must be used to supplant or supple- 
ment the natural diastase of the saliva. When cooked starch, 
as farina, arrowroot, tapioca, rice, is eaten, salivary diastase acts 
quickly upon it and liquefies it. This is accomplished when 
the food is in the mouth, if the patient is in good health, and 
while it is passing down into the stomach, before the contents 
of the stomach becomes acid. When a hearty meal is swallowed, 
it takes a little while for the gastric juice to permeate the mass, 
and a little longer time for all the acids of the body to aggre- 
gate to the stomach, consequently the acids of the contents of 
the stomach for a short time are quite feeble ; consequently 
nature points out the time to take malt extracts — either with 
the starchy food before a meal, or immediately after; never 
when digestion is at its height, for then the stomach is intensely 
acid, and the diastase would at once be killed. So the rule of 
giving farinaceous food after a meal, as is usually done, is 
essentially wrong ; it should be taken before a meal, for the 
first instead of the last part. This rule should be rigorously 
adopted in all conditions of debility in children, dyspeptics, 
and invalids. 

Infants should never be fed upon starchy food, because their 
salivary digestion of starch is not developed, or but imperfectly, 
till they reach over a year old, some later; if hand-fed, malt 
extract must be used. 

In order, therefore, to secure all the advantages that can 
possibly be derived from malt extracts, it is necessary to follow 
nature's processes, or to traverse them. Consequently malt ex- 
tracts should be taken with farinaceous food, and before meals, 
or immediately after such food; never when the stomach is 
full. It should be added to the farinaceous mass, with or with- 
out milk. It should never be added to anything hot, because 
diastase is killed at a temperature of 147° F. ; consequently when 
the food has become so cool that it can be sipped, the malt 
extract should be added. It should be either mixed through- 
out the farinaceous mass, or eaten with it, according to the 
nature of the food ; or it can be swallowed after the starchy 
mass, before the stomach has time to become acid. Such is 
the proper way to use malt extracts to obtain their full benefit. 

While there are many preparations of malt in the market, 
manufactured from mixtures of various cereals, such as wheat, 
oats, rye, etc., claimed to be equal to the true extract of malt, 
we regard this assertion as far from being established, as there 
is no grain capable of producing true malt ingredients but 



REMEDIAL AGENTS. 783 

barley ; and the farther north it has grown, as in Canada, Ohio, 
and Michigan, the better 

Independent of an aid to natural digestion, or an artificial 
digester of starch, malt extracts do possess some little value in 
the way of general nutrition, as they contain the phosphate of 
the grain, and a certain portion of starch transformed into sugar 
or dextrine ; so that the} r can be added to milk for invalids and 
dyspeptics, or for young children. Let it be ever borne in 
mind that diastase does not exist in the saliva of a white infant 
— not in sufficient abundance to digest starch — till about a year 
old. Until this period it is worse than useless to feed farina- 
ceous food of any kind. 

As a beverage, malt extracts may be added to drinks, such 
as milk and water, and thus form a sustaining drink in hot 
weather. Malt extracts are of great value in wasting diseases, when 
both their nutritive and digestive elements come into use, in such 
affections as phthisis, tabes mesenterica, want of nutrition from ex- 
hausting brain-work, debility, and indigestion ; that is, if the article 
is good. In their purchase, it is well to be very guarded, as no 
class of remedials have been so scandalously adulterated, and 
none in which such vile imitations and worthless articles sub- 
stituted. 

Pepsin. 

The active principle of gastric juice can be obtained from the 
stomachs of many animals ; but, as the stomach of the pig and 
gizzard of the chicken have the strongest digestive property, 
they are very generally preferred to all others ; they are also 
easily procured, and are very cheap. They may be prepared 
in a great variety of ways, as by cleaning and drying, and add- 
ing to wine and other substances. But for home purposes, and 
a most superior article, the following is the best mode of prep- 
aration : Take the stomach, cleaned roughly at first, then cut 
it up into pieces, and dissect off the mucous membrane or coat, 
with a little care, and then spread it on a flat board ; then take 
a sponge and a little water, and wipe off, and remove all extra- 
neous matter ; then with a piece of ivory or hard wood, made 
like a knife, the surface is scraped hard, so that the microscopi- 
cal glands be squeezed and their contents pressed out. The 
viscid mucus thus obtained contains the pure gastric juice, with 
much epithelium from the glands and surface of the mucous 
membrane. Then spread this on a piece of glass, so as to form 
a thin layer, and dry it at a temperature less than 100° F. The 
heat must not exceed 100°, because if it does, it is destroyed. 
When perfectly dry, the mucus is to be scraped from the glass 
and put into a mortar, and reduced to a fine powder, and then 
transferred to a well-stoppered bottle. This powder excels all 



784 KEMEDIAL AGENTS. 

others in digestive properties. Take of this powder, either 
before meals or after, from two to five grains, and dissolve it in 
a little w T ater, to which add from three to five drops of muri- 
atic acid ; mix, and take at once This powder undergoes no 
change, no decomposition, if kept in a stoppered bottle and dry, 
and contains pure pepsin — the active principle of the gastric 
juice unaltered — and is better than anything else in the market. 

The ingluvin, said to be prepared from the chicken's gizzard, 
can be made in the same way, and same dose. That which is 
advertised b}^ the so-called manufacturing druggists is simply 
the gizzard, dried at a temperature of 100° F., and ground 
into a powder ; so that to obtain a result, it is necessary to 
administer in twenty or thirty-grain doses. 

Our pepsin, as above described, can be administered without 
the acid, if desired, and triturated w T ith sugar of milk instead ; 
but the acid is the best form. 

It is useful in all diseases of malnutrition, malassimilation, emaci- 
ation; in all forms of vomiting, diarrhoea, indigestion; invaluable 
in diphtheria, typhoid ; excellent in debility of young children or 
aged adults; arrests cholera infantum, aphthse, scarlet fever, small-pox, 
sea-sickness. 

Our best chemists have asserted, and all are agreed on the 
point, that the dried mucus of the pig's stomach is the most 
active, and twenty-five times stronger than all other forms, or 
from other animals. 

ACUPUNCTURATION. 

This method of treatment consists in the use of an instru- 
ment in which are inserted fine needles, their points outwards, 
ranging from a dozen to fifty to the square inch. They are 
either arranged with a spring or otherwise ; but their design is 
to prick the skin, and thus stimulate the nerves. Some enthu- 
siasts go further in applying it violently, so as to cause deep 
punctures, and then to rub over the part medicinal agents, ac- 
cording to the nature of the disease. Suppose it was a fever, or 
inflammation, it would be applied over a part ; then veratrum 
viride, aconite, rubbed up in oil of mustard, would be used, or 
liniment of croton oil. Suppose an action of the liver was de- 
sired, the instrument would be applied over that gland, and 
then extract of mandrake. It is a clumsy and severe method, 
and is best adapted for chronic inflammation of spinal chord, 
such as exists in spinal irritation and hysteria. Here, applied 
on both sides of the spinal column, away from bony projections, 
it operates like a charm. After it is applied, oil of mustard is 
very efficacious in keeping up the stimulation. It may be re- 
peated as soon as all indications of soreness have subsided, again 
and again. In its use be careful not to prick the periosteum 



REMEDIAL AGENTS. 785 

over any bony point. It should never penetrate deep ; its best 
effects are to be obtained by stimulating the surface. It must 
never be used near a joint, nor on children. It has a wide range 
of action, but should be limited to anaemic conditions of the 
cord, for which it is so serviceable. If remedies are used with 
it, let them be simple ones, never using any powerful drugs. 

The reflex effect, if performed gently, is to strengthen the 
nerve-centres. 

ALTERATIVES. 

There are two processes going on in the human body at one 
and the same time : construction and destruction. In healthy 
adults they are about equal ; but if alteratives were given they 
w T ould create an excess of waste ; they would produce a change; 
break down tissue. They are useful in the destruction of living 
poisons, and in their subsequent elimination from the body ; 
as they all stimulate the skin, kidneys, and bowels. 

Standard Vegetable Alteratives. 

Compound syrups of frostwort, yellow dock, caulophyllum, 
stillingia, sarsaparilla, poke-root, saxifragica, are excellent vege- 
table alteratives. Or, what is cheaper, are, infusions of sassa- 
fras, yellow dock, corydalis, blue flag, agrimony, bitter-sweet, 
burdock, tag alder, frostwort, sheep laurel, unicorn. These in- 
fusions can all be preserved in the hottest weather by dissolv- 
ing from a half to a teaspoonful of chloroform in a tablespoon- 
ful of alcohol, and mixing ; then adding to a pint infusion and 
bottling up, keeping it corked. Iodide of potassa can be added, 
as they are taken to the amount of five grains three times a 
day. We never use mercury as a blood purifier. 

Stillingia and Iodide of Potassium. 

Take four ounces of the compound syrup of stillingia ; one 
ounce of the tincture of kalmia ; two drachms of iodide of potass ; 
three of the bicarbonate of potass: mix. One teaspoonful 
three times a day before meals. Invaluable in syphilis, tubercle, 
cancer, and all blood diseases; also in "poisoning by mercury, lead, tin, 
bismuth — all blood poisons. 

Phytolacca and Iodide of Potass. 

Take six ounces of the compound syrup of phytolacca, or 
poke root ; three drachms of iodide of potass ; and half an 
ounce of bicarbonate of potass: mix. Dose, one teaspoonful 
thrice daily, before meals. Excellent in syphilis, cancer and all 
diseases of the blood, and its efficacy is quadrupled if ozonized. 

Podophyllum, and Other Vegetable Agents. 

Take ten grains of the resin of podophyllum ; twenty grains 
of the resin of golden seal ; twenty of the extract of gentian ; 

62 



786 REMEDIAL AGENTS. 

twenty of the extract of cinchona ; and sixty grains of extract 
of conium. Make forty pills ; one to be taken three times a 
day. Very valuable in all blood diseases, especially syphilis and 
cancer. 

Iodine. 

In the body of the work we have recommended iodine pure, 
combined with starch, as a valuable alterative (see Lupus) ; tinc- 
ture of iodine with sweet milk, in cases of tubercular disease 
in children ; and iodide of potassium and sodium in general 
disease of the blood, as destroyers of disease-germs. There are 
other preparations, as iodide of iron, that are not of much 
utility. 

Iodide of Lime. 

Is a most excellent form in uterine diseases. The syrup is 
the best form for administration ; its effects often surpass the 
iodide of potassium. A teaspoonful thrice daily. 

Iodide of Potass and Iodide of Soda 

Are best administered in the alterative syrups, but they can 
be added to infusions, or simple water. The average dose is 
five to ten grains, thrice daily. Good blood purifiers and germi- 
cides. 

Chloride of Lime. 

Take half an ounce of chloride of lime; two ounces of tincture 
of orange-peel, and one of water. Mix well, and filter and strain 
carefully. Dose, a teaspoonful three times daily in water. Very 
efficient alterative in enlargement of the lymphatics. 

Colchicum, 

Take of the wine of the root of colchicum one ounce ; fifteen- 
drops doses every three hours, until it acts upon the bowels ; 
then in small doses — three to five drops — so as to keep up its 
action. Often of great efficacy in beer drinkers, to eliminate urea. 

Add twenty grains of sulphate quinine to the ounce, and take 
in same doses. Valuable in gout. 

Benzoic Acid. 

Take a drachm of benzoic acid ; add glycerine in sufficient 
quantity to make a mass ; then divide into twenty pills ; three, 
thrice daily. Good in jaundice, from suppressed action of the liver; 
and in incontinence of urine. 

Chlorate Potass. 

Put two drachms of chlorate of potassa in four ounces of 
water, and add to a pint of lemonade ; a wine-glassful every 
three hours, in blood-poisoning. 

Anti-Rheumatic Alterative. 

Take four ounces of the compound syrup of yellow dock ; 



REMEDIAL AGENTS. 787 

one ounce of the wine of colchicum ; three drachms of the 
iodide of potass ; two of bicarbonate of potassa ; and half an 
ounce of tincture of black snake-root ; mix. Dose, a teaspoon- 
ful every three hours. Very valuable in chronic rheumatism. 

Sulphur. 

Take, say one hundred grains of sulphur; add to it confection 
of roses, sufficient quantity to make a mass, which divide into 
forty pills. Dose, from three to four, morning and night. Of 
great utility in blood diseases and piles. 

Blood-Maker and Purifier, 

Add one-half ounce of sulphate of manganese to one pint of 
water. This is superior to iron as a tonic, and an excellent blood- 
purifier. Dose, a wine-glassful three times a day. 

Alterative Syrup. 

Mix two ounces of tincture of myrrh ; two ounces of tincture 
of lobelia ; half ounce of tincture of capsicum in half pound of 
molasses. A teaspoonful three times a day. A very superior 
alterative in chronic disease. 

Alterative Pill, 

Take two drachms of pulverized green lobelia ; the same of 
mandrake, blue flag, bloodroot, cayenne pepper, gum-guaiacum ; 
one drachm of oil of peppermint ; extract of dandelion to make 
into three-grain pills. The amount of dandelion present should 
be about 6 drachms. If mass is too dry, add simple syrup. It 
is designed to make four hundred pills, of which two or three 
should be taken three times a day. Valuable in liver, skin, tuber- 
culse, and syphilitic diseases. 

Alterative for Rheumatism. 

Macerate for two weeks one ounce of bitter-sweet, half an 
ounce of colchicum seed, and half an ounce of black snake-root; 
put the whole into a pint of rye whisky. A tablespoonful three 
times a day. 

Gum- Guaiacum. 

Take one ounce of gum-guaiacum ; two drachms of saltpetre ; 
and two drachms of salicylic acid ; add the whole to one quart 
of good old whisky. Dose, one tablespoonful every three hours. 
Very useful in rheumatism. 

Tincture of Sulphur. 

Take a tablespoonful of sulphur, and put it in a two- ounce 
bottle, and cover with alcohol at 95 ; let it steep two weeks. 
Dose, ten to thirty drops three or four times a day. Excellent 
in skin-diseases, piles, and whenever an alterative is indicated. 



788 REMEDIAL AGENTS. 

ANAESTHETICS. 

Anaesthetics are a class of agents that are used by inhalation 
to blunt the sensibilities of the patient to pain, and thus prevent 
shocks, and obviate, or ward off to a very great extent, surgi- 
cal fever, in all great operations. There are a great number of 
agents of this class ; but three, viz., nitrous oxide gas, ether, and 
chloroform, are what may be termed safe and reliable. 

Nitrous oxide gas is used solely for very short operations, as 
the opening of abscesses, making incisions, and extracting 
teeth — where anything can be done in a few seconds ; for a 
prolonged use of the anaesthetic is dangerous, and it should 
never be given more than once on one day, and not for several 
days afterwards. It is useless in operations of any magnitude. 

Ether is a good anaesthetic, from six or seven years of age up 
to sixty, because of its great safety, and the fact that it increases 
the heart's action. 

Chloroform is best for children or elderly persons whose hearts 
are in good condition ; but it must be watched, as it decreases 
the action of the heart. 

The inhalation of ether by aged persons excites immense 
activity and congestion of the bronchial glands, so that it is 
very apt to prove fatal. It has the same effect in children, 
although they, as a rule, take any anaesthetic well. 

The process of anaesthesia may be divided into three stages: 
the first being that of cerebral excitement, or loss of conscious- 
ness ; the second, accompanied by loss of sensibility ; and the 
third, by loss of motion. Beyond this it is unnecessary to go ; 
it is the filial stage — total paralysis of the nerve-centres. Gen- 
erally speaking, the second stage is sufficient for most operations. 

Preparations for Administering Anaesthetics. 

May be divided into ordinary and special preparations. 

The ordinary preparations consist in seeing that no meal is 
taken for four or six hours previous to the anaesthetic. The 
patient is usually in a high state of nervous excitement, and 
the function of digestion is retarded ; and it is even better to 
omit the meal altogether, so as to avoid the sickness produced 
by the anaesthetic. 

When food is in the stomach, patients are longer in getting 
under the influence of the anaesthetic ; but as soon as vomiting 
takes place, they speedily become insensible. Sickness, in the 
true sense of the term, or the bringing up of the contents of 
the stomach, seldom occurs when patients have been properly 
prepared. The special preparations are to be observed if the 
patient is feeble, or affected with some disease, or anaemic. 
Great caution must be observed, and perhaps tonics and nutri- 
tious diet should be resorted to for some days or weeks before 



REMEDIAL AGENTS. 789 

the anaesthetic is given. If nitrous oxide gas or ether is to be 
given, do not let the patient touch alcohol or brandy in any 
form, as it introduces a factor in the case which is not desirable, 
preventing the action of the anaesthetic altogether, or causing 
the patient to become wild and uncontrollable. If chloroform 
is to be given, brandy and water may be given before to stiffen 
up the action of the heart, or, what is better, fifteen grains of 
chloral hydrate, in syrup of orange-peel, about an hour before. 
Bowels and bladder should both be evacuated. Examine the 
chest, lungs, and heart ; see that there is no inflammation of 
the air-cells, or bronchial tubes, or cardiac disease, and no 
pregnancy. Pare chloroform alone, when there is lung irrita- 
tion ; when the heart's action is feeble, ether. The patient, 
having been prepared, should, if for gas, be placed in the dental 
chair, in the usual position for extraction ; if for any other 
operation, upon his back on a table, with the head slightly 
raised, and all constriction of neck-ties, or stays, or bands, or 
tight-fitting garments, removed from chest and abdomen. Arti- 
ficial teeth, if worn, should be removed, or any other substance, 
from the mouth. When administering any anaesthetic, the first 
inhalations should be freely diluted with air, and the patient 
caused to take deep inspirations, so as to get gradually under 
the influence ; for larger quantities, suddenly placed over the 
patient's mouth, occasion gasping and struggling for breath. 

It is to be borne in mind that nitrous oxide gas produces, in a 
large number of cases, a livid or purple appearance of skin, of 
face, and neck; ether, congestion or redness ; chloroform, a pale- 
ness or pallor. Ether, in its administration and evaporation, 
produces much irritation of the bronchi, buccal, and respiratory 
glands ; consequently the secretion of the respiratory tract is 
greatly increased, flows about in all directions, about the fauces 
and down into the stomach, whence sooner or later it must be 
ejected. If the patient's head be inclined to one side, so that 
the saliva can partially flow away by the angle of the mouth, 
this is lessened. 

To know when the patient is sufficiently under the influence of any 
ansesthetic, touch the conjunctival surface with the tip of the 
finger, and if no reflex action takes place, as is shown by the 
contraction of the orbicularis palpebrarum muscle, a sufficient 
degree of insensibility has been produced. 

In a large number of cases it is not necessary to have pro- 
found anaesthesia. When the patient is fully under it, disturb 
him as little as possible. The skin, of all textures, is abundantly 
supplied with sentient nerves, and is the most sensitive part of 
the body, so that the first incision and the sewing up of the 
wound are more painful than the cutting of the muscle or the 
sawing of the bone. 



790 REMEDIAL AGENTS. 

One person should administer the anaesthetic, and never leave 
his post, nor think nor do anything else. His business should 
be to give the anaesthetic, and that alone, and watch the breath- 
ing and pulse. His own breath should hang on the breathing 
of the patient, so that he cannot breathe himself till his patient 
breathes. With ether there maybe a slight spasm, respiration 
may stop ; a tap on chest, or rotating the head slightly, will 
cause it to resume. If the inspiration is difficult, go slow ; 
remove mucus from fauces with fingers, and pull the tongue 
forward. 

Purity of the Anaesthetics. 

Nitrous oxide gas is best prepared from the fumes of nitrate 
of ammonia, boiling gently. The gas so evolved should run 
into a wash-bottle of water, to cool, then into another, with water 
in which a stick of caustic potassa has been dissolved, to destroy 
any fumes of nitric acid in the gas ; and then allow it to run 
through a third wash-bottle, to still further cleanse; from this 
it should run into the tank. It should never be used warm, as 
it produces asphyxia. It should not be breathed from the 
tank, as one patient may breathe another's respired gas, but 
from a rubber bag of sufficient capacity to give the result. 

Ether and chloroform should be pure, and dropped upon a 
sponge, or small towel, inserted into a newspaper in the shape 
of a cone, which is placed over mouth and nose. Begin gently, 
letting the patient breathe air. Stertorous breathing is a sign 
the patient is over — that the operation may begin; stertorous 
breathing is an indication that the patient is all right ; but 
hold up the anaesthetic, and watch the breathing well. 

Chloroform should be kept covered from air and light, and 
before using, its purity should be tested, as follows : put equal 
volumes of chloroform and colorless concentrated sulphuric 
acid in a stoppered bottle, and shake well ; if pure, there should 
be no tinge, or but a very slight one, imparted to the acid after 
standing twelve hours ; neither should there be any sensible 
heat by the mixing. 

Chloroform, as it evaporates from bibulous paper, should give 
but little foreign odor, and that only as the last portion is pass- 
ing off from the paper ; and the paper should be left colorless. 

No anaesthetic is absolutely safe, so that they never should 
be administered unless absolutely necessary. They should, 
when given, be administered by an old, experienced physician, 
who understands their action, and all emergencies provided for. 
It should never be prolonged more than is really needed. 

Prolonged Anaesthesia. 

Once the patient is under the nitrous oxide gas, its action 



REMEDIAL AGENTS. 791 

can be prolonged by causing him to inhale either chloroform or 
ether for a few minutes. 

A mixture of alcohol, one part; chloroform, two parts; ether, 
three parts : mix ; shake well. Is most excellent for profound 
muscular relaxation, and when we desire anaesthesia prolonged. 
It is invaluable in fractures, taxations, hernia, spasm, and other 
conditions requiring complete relaxation. The same could be 
preceded by a dose of chloral hydrate, or followed by a hypo- 
dermic injection of a quarter of a grain of sulphate of morphia 
in solution. This is only necessary in long, tedious operations. 

Maintained Anaesthesia. 

Is best performed as follows : When we are desirous of pro- 
longing the action of chloroform, and using little of it in a 
long, tedious operation, begin with the administration of the 
chloroform in the usual manner, say ten drops on a towel in 
the cone of a newspaper, then another ten and another ; then, 
just as you are dropping the third ten, inject under the skin of 
the deltoid, on the shoulder, either a quarter or a third of a 
grain of sulphate of morphia in solution ; continue the chloro- 
form till the cornea becomes insensible to the light. This gives 
us complete and prolonged anaesthesia, with very little chloro- 
form, free from all risks; and with twenty or thirty drops it can 
be maintained for over half an hour, without the least unpleas- 
antness or possible danger. 

The condition of the patient and the character of the opera- 
tion to be performed will guide us to the mode of administra- 
tion. 

The administration of anaesthetics in eye operations requires 
nice adaptation. In the removal of cataract, to avoid cough- 
ing, struggling, at the critical moment of extraction of the lens, 
the alcohol, ether, and chloroform mixture should be preferred, 
and so on with other forms. 

Ether is apt to cause a failure in the respiration, whereas 
chloroform causes a failure in the pulse. 

When the operation is completed, and the anaesthetic action 
not further needed, throw up the windows for fresh air ; beat 
the hands ; sprinkle cold water on the face ; use friction ; shake 
gently, rouse up ; and as soon as able to walk, long, deep in- 
spirations in the open air. A little aromatic spirits of ammonia 
or brandy may be given. AVash face and hands in cold water. 

Nitrous oxide gas, ether and chloroform, are, upon the whole, 
safe and reliable anaesthetics, and the new anaesthetics have not 
superseded them ; and it is not well to abandon them for new 
remedies that are even still more dangerous. But, although we 
deem them upon the whole, safe, great discrimination and care 
with proper precautions, are necessary in their administration. 



792 REMEDIAL AGENTS. 

Iii long ansesthesia cover patient well up, so as to maintain the 
natural heat. In cases of threatened asphyxia, never trust 
solely to pushing the lower jaw forward out of its socket, but 
forcibly drag the tongue out and forwards by the forceps. Arti- 
ficial respiration must be immediately commenced and carried 
on until all hopes of recovery have ceased. If air enters the 
lungs it can be heard, or its moisture can be seen on a mirror 
if held over mouth. 

Besides these means, friction and artificial heat to feet and 
legs ; cloths, taken from boiling water, placed over the region 
of the heart ; enemata of turpentine into the rectum, or a piece 
of ice in rectum and vagina. 

Hot water over the heart, even to instantaneous vesication, 
will often restore the heart's action when it has ceased to beat. 
This should never be overlooked, and should be always in 
readiness. The medicinal agent that seems to promise most as 
an antidote to chloroform and ether poisoning, is the nitrite 
of amyl. Physiological experiments have developed the an- 
tagonism between the effects of the nitrite of amyl and chloro- 
form. While chloroform repairs reflex excitability and pro- 
duces contraction of the cerebral vessels, nitrite restores this 
excitability and causes their dilation ; into the enlarged vessels 
the blood freely enters, and a rapid circulation follows The 
merits and demerits of nitrous oxide, chloroform, and ether, 
may be briefly expressed thus : 

The advantages of nitrous oxide are its safety, and in that it 
can be given under all conditions except pregnancy. 

Advantages of Chloroform. — It is agreeable to breathe, rapid in 
its action in producing complete insensibility ; no laryngeal 
nor bronchial irritation ; does not readily cause vomiting ; and 
its influence is easily maintained. 

Its great disadvantages are, that it is liable to produce cardiac 
syncope, and thus stop the movements of the heart; besides, it 
often causes paralysis of the respiratory nerve-centres, and thus 
arrests the action of the respiratory muscles. 

Advantages of Ether. — Some think it safer than chloroform, 
because it does not arrest the circulation, nor kill by cardiac 
syncope. 

Its disadvantages are, that it is unpleasant to take; requires 
a long time to effect unconsciousness ; requires a great quan- 
tity ; causes restless excitement ; most excessive bronchial secre- 
tion ; gives rise to unpleasant taste in the mouth for several 
days. The advantages of the mixture of alcohol, chloroform 
and ether are, that it unites the advantages of both, and the 
disadvantages are reduced to a cypher. 

Local Anaesthesia. — This consists in freezing the part by a 
spray of sulphuric ether, by means of an atomizer. 



REMEDIAL AGENTS. 793 

It is a valuable mode of procedure for the freezing of gums 
for the painless extraction of teeth ; for the removal of fibroid, 
fatty, or sebaceous tumors, if not too large, or deep-seated ; also 
valuable for various minor operations. 

ANODYNES. 

Medicines that increase the vital functions of the nervous 
system ; if not brain-food in themselves, have the property of 
causing the nervous system to pick up more pabulum from the 
blood. Useful in all diseases, especially when the nervous sys- 
tem is shattered or exhausted ; sleeplessness ; nerve-exhaustion ; 
overwork; physical and mental debility, or pain; and in disease 
generally. 

Opium. 

Take ten grains of pulverized opium ; thirty grains of Dover's 
powder ; and thirty grains of pulverized asclepias : mix. Make 
twenty powders. On£ every hour, or two, three, four, or more 
hours apart, as indicated, in warm tea or gruel. A good form 
in which to give opium in pleurisy, gastritis, peritonitis, metritis. 
Camphor can be added if desired. 

Morphia. 

Take four ounces of cinnamon-water; four grains of sulphate 
of morphia ; fifteen grains of bicarbonate of potassa : mix. A 
teaspoonful every hour, or two, three, or four hours, as indicated, for 
sleep, peritonitis, after-pains. 

Chloral. 

Take hydrate of chloral, two drachms ; syrup of orange-peel, 
two ounces : mix. Two teaspoonfuls at bedtime ; or, in cases 
of delirium tremens, every five or ten minutes. 

Chlorodyne. 

Consists of a mixture of chloroform, morphia, Indian hemp, 
opium, and other anodynes. Dose, thirty drops in water, as 
indicated. Good to relieve pain. 

Hyoscyamus. 

Take of the solid extract of Hyosciamus (English), sixty 
grains ; pulverized opium, five grains ; sugar of milk, two 
drachms: mix, and rub up into a powder very fine, then divide 
into thirty parts. One every two hours. One of our best ano- 
dynes in inflammation of the brain ; acts promptly on the holloiv vis- 
cera, stomach, bowels, bladder; and almost immediately relieves stran- 
gulated hernia. 

Lobelia. 

Take half an ounce of the ethereal tincture of lobelia ; aro- 
matic spirits of ammonia, two drachms; tincture of aconite, 



794 REMEDIAL AGENTS. 

twenty drops; camphor- water, half a pint: mix. One table- 
spoonful every two hours. Useful in asthma, but more especially 
in the difficult breathing of bronchitis. 

Opium and Ipecac. 

Take powdered opium, five grains ; pulverized ipecac, ten 
grains ; nitrate of potassa, sixty grains : mix. Make ten pow- 
ders. One occasionally, in chronic cough. 

Wild Cherry. 

A cold infusion, drunk freely, is invaluable as a sedative. 

Croton Chloral (Neuralgia). 

Take of croton chloral forty grains ; sulphate of quinine, 
twenty grains ; glycerine, a few drops, to make it into a mass. 
Make twenty pills. One to be taken before an attack, or during 
an attack ; take often till relieved. Affords almost immediate 
relief from pain in neuralgia. 

If patient has an aversion to pills, then make the following : 
Take sixty grains of croton chloral ; one ounce of glycerine ; 
three ounces of distilled water : mix. Shake well before using. 
Dose, a tablespoonful every fifteen minutes, until it is efficacious 
in relieving the pain. 

Guarana. 

Teaspoonful doses of the fluid extract of guarana, adminis- 
tered every five or ten minutes, afford instant relief of all forms 
of sick-headache. Besides, it fortifies the system against all 
shocks, and gives great powers of endurance to the human 
body. 

Bromohydric Acid, 

Take six ounces of syrup of squills ; one ounce of bromo- 
hydric acid : mix. One teaspoonful every three hours ; or in 
half teaspoonfuls very frequently, to relieve great distress. 

It is an invaluable anodyne in nervous exhaustion, excita- 
bility, hysteria ; allays vomiting ; exercises a powerful effect 
upon the brain and spinal cord ; hence it is of great utility in 
cough, whooping-cough, painful uterus, and other distressing 
complaints. In cases of colic, or cramp of the bowels, add ten 
or twenty drops of chloroform to each teaspoonful. 

Nitrite of Amyl. 

This drug should be kept in pearls, with from five to eight 
drops in each ; because, if administered from a bottle, it loses 
strength, and you will be disappointed in its use. Break a pearl 
containing five or eight drops on an ordinary piece of rag, and 
inhale, in asthma, angina pectoris, sea-sickness, and in suspended 
animation from chloroform. It is a safe, volatile narcotic. Useful 
in lockjaw. 



REMEDIAL AGENTS. 795 

ANTACIDS, OR SALINES. 

Medicines that tend to neutralize acidity. Not much used 
now, as it has been demonstrated that acids tend to excite the 
normal alkaline secretion from all glands ; hence they are justly 
preferred. Besides, antacids, or alkalies, stimulate the mucous 
coat of the stomach so excessively as not only to relax it, but 
give rise to catarrh and ulceration of the stomach. 

Bicarbonate of Potassa. 

Take twenty grains bicarbonate of potassa ; dissolve in two 
ounces of water; take at one draught. The same to be taken 
every two hours till the urine is alkaline. It is sometimes of use 
in acute rheumatism. 

Potash and Lime- Water. 

Take a teaspoonful of lime-water ; fifteen to thirty drops of 
liquor potassa ; mix together, and then add to either a cupful 
of beef-tea or milk, two or three times a day. It will diminish 
the fat of the body, besides rendering the secretions alkaline. 

Fucus Vesiculosus and Liquor Potassa. 

Take six ounces of the fluid extract of fucus vesiculosus, and 
two ounces of the liquor potassa: mix. Dose, a teaspoonful 
twice or thrice daily in water. The best anti-fat remedy. It will 
rid the body of that non-vital element, fat, in a few weeks.. 

Magnesia. 

Take of carbonate of magnesia, bicarbonate of soda, of each 
twenty grains ; add to a warm infusion of sassafras, and take 
twice a day. Very valuable in nettle-rash and tetter. 

Lithia. 

Carbonate of lithia, or citrate of lithia, in five or six-grain 
doses, is very useful in gout, taken in soda-water, or plain water. 
Decidedly useful in diminishing the uric acid. 

Seidlitz Powder. 

Bicarbonate of soda, grains forty ; tartrate of soda, one hun- 
dred and twenty grains : mix, and make an effervescing draught, 
with thirty grains of tartaric or citric acid. 

Cream of Tartar Drink. 

Take tartaric acid, one ounce ; two ounces of white sugar ; 
syrup or essence of lemon, to flavor ; two pints of boiling water. 
When cool, use as a common drink in fever, constipation, or where 
there is great thirst. 

Bicarbonate Potassa Drink, 

Take half an ounce of bicarbonate of potassa ; water, one or 



796 REMEDIAL AGENTS. 

two pints ; then flavor with syrup of lemons. Drink freely in 
rheumatism or red gravel. 

Saline Lemonade. 

Take of common salt three tablespoonfuls ; half an ounce of 
chlorate of potassa ; a quarter of an ounce of tartaric acid ; one 
drachm of phosphate of soda; six ounces of lemon-juice; water, 
six pints, and flavor with syrups to suit : mix. As a spring drink 
to rouse up the action of the liver, it is invaluable. It may be drank 
freely. 

Colchicum and Chlorate of Potassa. 

Take half a pint of camphor-water ; two drachms of chlorate 
of potassa ; wine of the root of colchicum, two drachms ; liquor 
of citrate of ammonia, two ounces and a half: mix. One table- 
spooonful every hour, in gout. 

Phosphoric Acid Drink. 

Take two pints of infusion of barley; one ounce of glycerine; 
and three drachms of phosphoric acid : mix. Tablespoonful 
frequently. Excellent for assuaging thirst in fevers. 

Chlorate Potassa, 

Take one ounce of chlorate of potassa ; three of bicarbonate 
of potassa: mix. Divide into eight powders; one to be dis- 
solved iii a pint of barley-water for a day's drink. Good to 
render the system alkaline. 

Lime-Water. 

To make lime-water perfectly : Take eight ounces of carbon- 
ate of lime ; boiling water, sixteen pints. First slake the lime 
with a little water, and agitate ; then add the balance of the 
water, and let it steep twenty-four hours ; filter off the clear 
liquor for use. It is a useful remedy as an antacid, and also as an 
antiseptic ; destroys disease-germs. It can be given in teething, all 
fevers, and acid states, in from half a teaspoonful to a teaspoonful, 
ahvays in milk. 

Lime-water for washes and injections may be made by pour- 
ing boiling water on ordinary lime, and letting it stand over- 
night, and then taking the clear portion for use. 

Tartrate of Sodium. 

Added to water, and used for a drink, is a valuable antacid. 

Liquor Ammonia Acetatis. 

Take four ounces of the liquor ammonia acetatis ; one ounce 
and a half of sweet spirits of nitre ; half an ounce of the tinc- 
ture of iron; and thirty grains of the sulphate of quinine : mix. 
Dose, one teaspoonful every three hours, in fevers when an antacid 
is demanded. 



REMEDIAL AGENTS. 797 

Phosphate of Soda and Citrate of Potash, 

The phosphate of soda can be given in half-teaspoonful doses 
in water, or added to gruel or beef tea, in disease of the liver, 
with most beneficial results ; or it can be administered in alter- 
nation with the citrate of potash, in doses sufficient to keep the 
urine alkaline. Thus combined, they have a disintegrating 
action on stone in the kidney and bladder. Of great value in 
liver complaints and the uric acid diathesis. 

Citric Acid and Carbonate of Soda. 

Take one ounce of citric acid, and one of carbonate of soda ; 
mix them together. Then take a teaspoonful of this composi- 
tion, and add to a tumbler of water ; as soon as effervescence 
takes place, it should be drank. It is more pleasant than soda- 
water and very beneficial in torpid liver in the summer months. 

Clysmic Mineral Water. 

This is an unexcelled and indispensable antacid, and should 
be freely used in all affections of the kidneys and bladder. 

ANTISPASMODICS. 

Are remedies that tend to allay spasm, or muscular rigidity, 
and are useful in deranged states of the nervous system when 
there is no fever, or inflammation, or debility. They relieve 
spasm, wipe out, or suspend reflex impressibility, or excitation. 

Sumbul ; or, Musk-Root. 

From a half to a teaspoonful of fluid extract of musk-root 
every few minutes, by mouth, if patient can swallow ; or by 
enemata, if unable to get it down on stomach. Forms one of 
the most pleasant and efficient of all muscular relaxants, as it does 
not nauseate. Of great utility in spasms, convulsions, hysterical fits, 
or whenever there is great excitation of the nerve-centres. 

Lobelia. 

An infusion of the leaves, a small handful, to a pint of boil- 
ing water; let it steep a few minutes, and begin its use, either 
by mo*uth or rectum, as soon as sufficiently cool. Give enough 
to nauseate and relax, but never to vomit. 

Lobelia, Capsicum, and American Valerian. 

Take two ounces of lobelia — one of the plant, the other of 
the seeds ; one of capsicum, and one of valerian pulverized. 
Add the entire four ounces to one pint of brandy or whiskey. 
Shake well, and begin to use at once in from teaspoonful to table- 
spoonful doses, every few minutes. 

If unable to procure the above, then purchase one ounce of 
the fluid extract of lobelia, one ounce of capsicum in fluid ex- 



798 REMEDIAL AGENTS. 

tract, and one ounce of fluid extract of valerian, and mix the 
three together. Begin its administration in teaspoonful doses ; 
give every few minutes until spasm relaxes. If unable to swal- 
low, administer repeatedly by the rectum, in large doses. This 
is one of the very best of all antispasmodics, safe, reliable, and 
prompt in action. Capable, without the aid of hot bath or other 
measures, of relaxing the tetanic spasm of lock-jaw. Useful in all 
convulsions, epileptic fits, tetanus, hysterical jits, whenever spasm exists. 
It is a mixture that every family should keep on hand. 

Compound Powder, or Tincture of Lobelia. 

Composed of equal parts of lobelia leaves powdered ; blood- 
root powdered ; and skunk-cabbage root, mixed together, either 
in powder, or by pouring whiskey on it to keep it. In either 
case, small doses, repeated every few minutes, relieves the spasm 
of the glottis in whooping-cough, the contraction of the bronchi, and 
wheezing of asthma, and the spasm of the heart in angina pectoris. 
Never give in doses to cause vomiting. 

To Cure Cramps. 

Take half an ounce of chloroform ; one drachm of oil of 
camphor; one ounce of mucilage of gum-arabic; and one grain 
of the acetate of morphia : mix. Dose, one teaspoonful every 
two hours. 

APHRODISIACS AND ANAPHRODISIACS. 

Aphrodisiacs are remedies that are supposed to increase the 
sexual appetite and invigorate the organs of generation. They 
may be termed sexual stimulants, and are very few in number, 
consisting chiefly of the preparations of iron, cinchona, nux 
vomica, damiana, cantharides, phosphorus. 

Anaphrodisiacs, again, are believed to repress sexual desire, 
cat off the appetite, and are a very numerous class of remedies, 
and consist specially of the green root tincture of gelseminum, 
bromide of potass, camphor, lupulin, belladonna, digitalis; and 
all the acro-narcotic drugs possess this property in a remarkable 
degree. 

Damiana Compound. 

This is prepared by mixing equal parts of the true fluid ex- 
tract of damiana ; tincture of nux vomica ; tincture of cantha- 
rides ; and fluid extract of coca. Dose will range from twenty 
to forty drops. It has great efficacy in sexual debility, or lethargy of 
the sexual organs, whether due to abuse or old age. Many cases 
of partial or total impotence are cured by it in its ozonized form. 

Cinchona and Nux Vomica. 

Take four ounces of compound tincture of cinchona, and one 
ounce of tincture of nux vomica: mix. Dose, a teaspoonful 



REMEDIAL AGENTS. 799 

three times daily. A valuable sexual tonic and excitant; excellent 
in habitual constipation and in piles. 

Iron and Quinine. 

These two drugs are of great utility in deficient sexual power. 
They can be used in various forms : as one ounce of the tinc- 
ture of iron to four ounces of compound tincture of cinchona. 
Dose, a teaspoonful in water thrice daily. Or, iron, by hydro- 
gen, combined with quinine, grain for grain ; or, tincture of 
iron, one ounce ; quinine, twenty grains. Dose, twenty drops 
thrice daily in water. Or, half an ounce of phosphate of iron 
and one drachm of quinine, to half pint of brandy : mix, and 
shake well. Dose, one to two tablespoonfuls thrice daily. 

Spermatorrhoea Pill, 

As laid down in another part of this work, is the best com- 
bination to cut off sexual desire for a given time, and leave the 
organ more vigorous than before. 

Bromide of Potassa and Gelseminum, 

Take four ounces of camphor-water ; one ounce of bromide 
of potassa ; one ounce of tincture of green root gelseminum ; 
and two drachms bicarbonate potassa : mix. A teaspoonful at 
three, six, and nine P. M. Very effectual in cutting of the sexual 
appetite. 

Digitalis, Belladonna. 

Those and other acro-narcotics are objectionable, same as the 
bromide of potass, as they have the faculty of drying up, absorb- 
ing, and blighting the testes and ovaries. 

ANTISEPTICS. 

Antiseptics are a most valuable class of remedies, which 
prevent change or decomposition. A very large proportion of 
them enter the blood, and there they destroy all disease-germs, 
purify and cleanse that fluid. They have also septicidal power : 
destroy ferments, neutralize the action of some deadly poisons 
within the living organism, without affecting the blood or inter- 
fering with the power of sustaining life. 

Disinfectants. 

The most useful agents are, chloride of lime, quick-lime, car- 
bolic acid, permanganate of potass, chloralum, iodine, bromine, 
chloride of zinc, sulphate of iron, sulphurous acid gas, pow- 
dered charcoal, burnt coffee, dry earth. The sick-chamber 
should be kept sweet by a free use of a solution of permanga- 
nate of potassa in the bed-pan, and the tincture of iodine 
around in vessels. To disinfect a room, sprinkle powdered or 
stick sulphur over the red coals in an open furnace, or shovel, 



800 REMEDIAL AGENTS. 

shutting doors and windows. This evolves sulphurous acid 
gas, which is more penetrating than either chloride of lime or 
carbolic acid. 

Iodine is the most pleasant agent in a sick-room. It disin- 
fects and deodorizes, and is the most manageable of all remedies. 
Half an ounce, spread out on two saucers on the mantel, is 
sufficient ; replace it as it volatizes. If desired, place one of the 
saucers on the stove ; it will volatize at once, and be diffused 
through the room. It annihilates all living diseased germs with 
which it comes in contact, and admits of being breathed freely 
and easily by the patient and attendants. It is doubtful whether 
it is not the best disinfectant in small-pox. 

To disinfect a room with burning coffee beans, is of no avail ; 
neither is charcoal, thymol, nor carbolic acid of much use. The 
remedy which volatizes, and thus diffuses itself, is best. An 
efficient method of destroying diseased germs in the evacua- 
tions, is to pour in disinfectants upon them before they leave 
the room For cheapness and efficacy, a solution of the sul- 
phate of iron, or permanganate of potass, answers admirably ; 
and for large cess-pools, ten pounds of sulphate of iron, dis- 
solved in half a barrel of water, and poured in at the rate of one 
or two buckets a day till it is exhausted, will kill any diseased 
germ in the mass. Every father should see to it that every 
diseased germ from a child, or other person, suffering from con- 
tagious disease, is destroyed. The chloride of lime is efficient, 
but its smell is exceedingly disagreeable to most sick persons. 
The sulphate of iron has no smell, and is the cheapest and 
most valuable of all disinfectants for sewage, but it does not 
diffuse itself through the atmosphere. The solution of chloride 
of zinc is more expensive, very corrosive, and poisonous. Car- 
bolic acid is not very volatile, unless heated thrice daily ; then 
it is very efficient. Chloralum, obtained by the double decom- 
position which occurs when solutions of sulphate of alumina 
and chloride of lime are mixed together, is a very elegant dis- 
infectant. 

To Disinfect Body-Linen. 

Have a tub of water ready, in which a disinfecting solution 
is added ; one that will not rot or destroy the linen that may 
be placed therein; a tablespoonful of Condj/s fluid to a bucket 
of water is the proportion. Allow the clothes to remain in it 
an hour, and then transfer the linen to boiling water. Clothing 
can be disinfected by steeping them in a very sour water, ren- 
dered so by sulphurous acid, which has no effect on colors. 
Dry heat is a valuable disinfectant — say, from 200° to 300° F. 
— but it cannot be used in families. 



REMEDIAL AGENTS. 801 

Antiseptic Treatment. 

The principle recognized is as follows : In all cuts, incisions, 
wounds, breaches of the skin, etc., that simultaneously with 
the injury or lesion, the living matter concerned in the nutri- 
tion of the wound becomes degraded into diseased germs ; that 
by the application of antiseptics the part is stimulated suffi- 
ciently to prevent the degradation, and where the diseased 
germs are formed they are destroyed. The remedies employed 
for the purpose are carbolic acid, boracic acid, salicylic soda, 
compound tincture of benzoin, balsam of fir, oil of eucalyptus, 
charcoal, compound tincture of myrrh, and other antiseptics. 
There can be little doubt of the utility of the method. The 
acids, as carbolic, must be diluted, one ounce of the acid to six 
or ten of olive oil. No wound or ulcer should be treated in 
any way but by antiseptics, beginning with simple vaseline 
ointment, up. 

Chlorine, 
As a gas, is not fit for inhalation ; but as follows, it can be 
administered internally : Take two drachms of muriatic acid ; 
two drachms of chlorate of potassa ; and add them to four 
ounces of water : mix. To a little child, one teaspoonful can 
be given every two or three hours in half a teacupful of water ; 
and just when ready to take, dissolve half a teaspoonful of 
sugar in the mixture, so as to evolve the chlorine on the 
stomach, which is so vivifying and cleansing to the blood of 
all those suffering from contagious diseased germs. Invaluable 
in scarlet fever, diphtheria, small-pox, and other living poisons. 

Liquor Chlorinated Soda. 

A few drops in water every few hours are valuable in gan- 
grene of the lung, low fever ; destroys thefoetor, acts as an alterative. 

Permanganate of Potassa. 

The solution of permanganate of potassa is an excellent dis- 
infectant, and can be used internally, by injections, and locally. 
It destroys all disease-germs, even those of snake-bite. From 
one-half to one grain to a little water, internally ; and for 
washes, injections, etc., make the water a good violet color, and 
use profusely, in leucorrhcea, gonorrhoea, and as a wash. 

Chloride of Zinc. 

Take ten grains of chloride of zinc, eight ounces of water : 
mix. Add one or two tablespoonfuls to a little water. Use as 
a wash, gargle, when a disinfectant is needed. It is very effica- 
cious. 

Chloride of Lime. 

Take two ounces of carbonate of lime ; saturate it with muri- 

, 63 



802 REMEDIAL AGENTS. 

atic acid, and then add six ounces of water, and filter carefully. 
Each teaspoonful contains sixteen grains of the chloride of lime, 
which is a dose, and to be taken three times a day, added to 
half a teacupful of water. Valuable alterative in all disease-germs, 
scarlatina, small-pox; and so powerful is it that it is the only 
known remedy to destroy the sarcinae on the stomach. 

Sulphurous Acid. 

One of the best antiseptics in all disease-germs ; added to 
water, for internal use, just sour enough to be agreeable to 
drink ; and slightly stronger as a lotion or wash for sores, gon- 
orrhoea, leucorrhcea. 

Logwood. 

In infusion, extract, is not only an astringent, but a valuable 
antiseptic. 

Camphor, Menthol, Thymol. 

May be administered in capsules, and are valuable antiseptics ; 
or incorporated into ointments, lotions, where indicated. In- 
ternally, very valuable in cholera. Dose of either, about five grains 
every three hours. 

Sulphite Soda. 

Take from thirty to sixty grains of the sulphite of soda in 
double distilled cinnamon-water three times a day: mix. Ex- 
cellent in gastric catarrh, when the sarcinse ventriculi are on the 
stomach. Patient should eat unfermented bread when taking 
this. 

Chlorate Potassa. 

Take of chlorate of potassa, thirty grains ; glycerine, three 
teaspoonfuls ; tincture of iron, thirty drops; water, three ounces: 
mix. Give a teaspoonful every half hour, day and night, in diph- 
theria. 

Chlorate Potassa. 

Take four ounces of water, and add to it two drachms of 
chlorate of potassa and two drachms of muriatic acid : mix. 
One teaspoonful every three hours, in a little sweetened water. 
Invaluable in scarlet fever and diphtheria, and as a gargle in sore 
throat. 

Chlorate Potassa. 

Take of chlorate of potassa two drachms ; sulphate of qui- 
nine twenty grains ; muriatic acid, one drachm ; simple syrup, 
four ounces : mix. One teaspoonful every four hours. Very 
useful in aerating or cleansing the blood, in pneumonia, overcrowding. 

Saccharate of Sulphur. 

Take one pint of good brandy ; four ounces of New Orleans 
molasses ; and one and a half ounces of sulphur : mix well. 



REMEDIAL AGENTS. 803 

Dose from one to two tablespoonfuls immediately after eating. 
This has the effect on the stomach of preventing a change of 
certain elements into lactic acid, and thus in a few days will 
starve and stamp rheumatism out. It is important that the molasses 
be the old-fashioned treacle, as the modern syrup, made of glu- 
cose is decidedly poisonous. It should be well shaken before 
using. It arrests all ferment in the stomach. 

Chloride of Lime. 

Three grains, three times a day, in sweet milk, destroys the 
germ tubercle in the blood, and at once arrests night-sweats. 

Salicylate of Soda. 

Is a powerful antiseptic, and it is doubtful whether its great 
utility in rheumatism is not due to its faculty in arresting the 
process of fermentation. 

Strong Coffee for Chills. 

Make strong mocha or Java coffee, sweeten to suit, and add 
the same quantity of lemon-juice ; drink warm on an empty 
stomach. Often of utility in ague. 

Sulphur to Disinfect. 

Set fire to a small quantity of sulphur, close the doors care- 
fully, when the fumes will penetrate everything in the apart- 
ment. 

ARTERIAL SEDATIVES. 

Arterial sedatives are a most valuable class of remedies that 
stimulate the brain, and thereby restore tone, vigor, force to the 
heart, and thus control the circulation, diminish heat and pulse. 
Great caution is necessary in their use, as they are narcotics, and 
also have anodyne properties. Some of them act upon the blood, 
but their chief property consists in controlling the heart's action, 
decreasing heat and respirations. All act directly -upon the 
brain, and indirectly upon the heart and arteries. 

Aconite. 

Take of either the tincture of the leaves, or root, one teaspoon- 
ful, which add to four ounces of water (half a tumblerful) ; cover 
to prevent evaporation. Give a teaspoonful every fifteen min- 
utes till skin becomes soft, moist ; heat, pulse and respirations 
come down to near normal ; then continue the remedy at in- 
tervals of half an hour, hour, and two hours. Best adapted for 
fevers of children and women. 

Aconite and Sweet Spirits of Nitre. 

One teaspoonful of tincture of aconite ; one to two of sweet 
spirits of nitre. Mix in four ounces or half a tumbler of water ; 



804 REMEDIAL AGENTS. 

cover. Give a teaspoonful quite often, as above ; when fever abates, at 
longer intervals apart. 

Veratrum Viride, 

One teaspoonful of the tincture of veratrum viride added to 
four ounces of water (half tumbler). Cover to prevent evapor- 
ation. One teaspoonful every fifteen minutes, or more frequent 
in grave forms of inflammation of very vital organs, as brain 
and lungs, until pulse, heat and respirations are normal, then 
at longer intervals of half an hour, hour, two hours, holding 
the position gained. If too large a quantity happens to be 
given in the above way it will cause great prostration, cold, 
clammy skin, nausea, vomiting, diarrhoea, which is injtantly 
relieved by administering half a teaspoonful of laudanum, but 
well watched, there is no danger of such an occurrence. 

This is one of the best remedies in the entire materia medica 
for fevers and inflammation, it is so positive in its action — our 
only sure remedy in acute inflammation of the brain or lungs. 
It is best adapted to adult males, although it may be given in 
either sex, and also to children. 

Aconite, Veratrum Viride, and Sweet Spirits of Nitre. 

Take one teaspoonful of tincture of aconite ; one of veratrum 
yiride, and a small tablespoonful of sweet spirits of nitre ; add 
; the three to four ounces, or half a tumblerful of water : mix ; 
eover. Begin in high fevers, or inflammations, with a tea- 
spoonful every few minutes, as the pulse decreases every fifteen 
mwutes ; when the pulse is down to 65 or 70, every one or two 
hours ; regulate the frequency by the rate of pulse. The vera- 
trum in this form operates better than alone, much more kindly 
in its action, and can be given to both sexes during all ages. 
It is the grand remedy for all fevers and inflammations, and should 
be in every family. 

Aconite, Belladonna, and Veratrum Viride. 

Take of the tincture of aconite, one teaspoonful ; the same of 
the tincture of belladonna, and the same of the tincture of vera- 
trum viride ; add the three to four ounces, or half a tumbler- 
ful of water ; mix ; cover. Dose, one teaspoonful every fifteen 
minutes, till pulse reaches 65 or 70, then at longer intervals 
apart, every half hour, hour, two hours, to hold the position. 
That is controlling the fever or inflammation. As the bella- 
donna and aconite have a special action in this form, viz. : to 
increase the fluidity of blood, act on the nerves of the face, those 
of the throat, tonsils, and parotid, on the breast and uterus, 
hence this prescription is most valuable in acute tonsillitis, mumps, 
neuralgia, inflammation of the breast, uterus, testicle; but can be used 
in all fevers and inflammations. 



REMEDIAL AGENTS. 805 

Tincture of Green-Root Gelseminum. 

There are two tinctures of the yellow jessamine, one pre- 
pared from the dried rind of the root, the other from the rind 
when in a green state. The dry root tincture, as it is termed, 
is very poisonous, and not useful in fevers, but of value in neu- 
ralgia ; the green root is what is used in fevers, and as an ana- 
phrodisiac. Onetablespoonful added to hall a tumbler of water : 
mix, and cover. One teaspoonful every fifteen minutes till heat 
and pulse come down to 75 or 80 ; then at longer intervals. If 
the eyelids become sluggish or stiff, or the patient sees double, 
hold up its use. Never give to children. It is best adapted for malarial 
fevers, ague, remittent, bilious intermittent, or remittent yellow fever, 
inflammation of stomach, liver, peritonseum, uterus. It can be com- 
bined with aconite, veratrum viride, when a powerful action is 
desired, as in malignant remittent. 

Tincture of Veratrum Viride, Aconite, and Gelseminum. 

One teaspoonful of tincture of aconite; one of veratrum 
viride, and one tablespoonful of tincture of green root gelsemi- 
num: mix, and add to four ounces of water. Administer in 
teaspoonful doses every fifteen minutes till pulse, heat and res- 
pirations come down to normal standard, then every half hour, 
hour, or two or three hours apart. Hold the position gained 
carefully. 

Tincture Green Root Gelseminum and Quinine. 

Dissolve five, ten, twent}^, or more grains, of sulphate of qui- 
nine in a little water, with tartaric acid; then add one tea- 
spoonful of tincture of green root gelseminum, and take for a 
dose an hour before an ague chill, or during the progress of 
remittent, bilious, or yellow fever ; it may be repeated if neces- 
sary. It will often break up that class of fevers. 

Tincture of Digitalis. 

May be used in fevers, especially scarlatina, combined with 
aconite and belladonna. It must be carefuly watched. Not 
much used, but never should be omitted in scarlatina. Dose 
will range from one to two drops every three hours, according 
to the age of the child, 

Quinine and Salicylate of Soda. 

Give alternately, in doses ranging from two to five grains, 
every two hours, so as to reduce heat, pulse, and respirations 
to a normal standard. 

Other Arterial Sedatives, 

Such as bathing, sponging, shampooing, recumbent posture, 
use of antiseptics in all diseases, stimulants ; in other words, 
any procedure, or remedy, that aids in raising the standard of 



806 REMEDIAL AGENTS. 

vitality, is to be regarded as an arterial sedative. Nauseants, 
like lobelia, ipecac ; and saline diuretics, as cream of tartar, 
nitre, are also arterial sedatives. 

Digitalis, Aconite, and Belladonna. 

Add one teaspoonful of tincture of aconite, tincture of bella- 
donna, and tincture of digitalis, to four ounces of water (half 
a tumblerful). Give a teaspoonful every two or three hours. 
Most invaluable in scarlet fever. 

Tincture of Lobelia. 

Administer a few drops of the hydro-alcoholic tincture of 
lobelia in water, or a tea of asclepias, or with compound tinc- 
ture of serpentaria. It has a most wonderful effect in lowering 
the pulse, heat and respirations ; continue with it till they are 
normal ; never nauseate or cause emesis. The hydro-alcoholic 
tincture is made of the leaves, stems, and seeds of the plant, in 
equal portion, and with alcohol reduced to 45, or the same 
strength of whisky. 

Another excellent plan is to add one heaped teaspoonful of 
pulverized lobelia-leaves to one teacupful of boiling water; 
infuse for an hour, then sweeten, and give half or a full tea- 
spoonful of the infusion ever half hour till pulse comes down 
to a natural standard. It is of the greatest value in bronchitis, or 
colds, infantile catarrh. 

ASTRINGENTS. 

Astringents are medicines that contract the living fibre. 
Astringents cause contraction, greater firmness of muscle, di- 
minished calibre of blood-vessels, greater tension and rigidity 
of absorbents, and a closure of secreting orifices, and checking 
of secretions generally. They promote moderate and permanent 
excitement of organic life. They do not influence the nervous 
system, or the function of animal life. They are very useful 
in haemorrhages, diarrhoeas, catarrh, or other relaxation. They 
consist of both vegetable and mineral substances. 

Cranesbill, Bayberry, Strawberry Leaves. 

Infusion or decoction of the entire three combined, or any 
one of them, makes a pleasant, agreeable astringent. Drink 
freely. Excellent in diarrhoea, and as an injection. 

Tannin and Logwood. 

Take of tannin, pulverized opium, each ten grains ; sulphate 
of quinine ten grains ; and of extract of logwood thirty grains. 
Make twenty pills, and take one after every motion of the 
bowels when they exceed one per day. Good in diarrhoea, after 
the bowels have been acted on by a cathartic. 



REMEDIAL AGENTS. 807 

Catechu, or Kino, and Chalk Mixture. 

Take of tincture of either catechu or kino, one ounce ; chalk 
mixture, an ounce ; paregoric, one drachm : mix. Half to a 
teaspoonful every three or four hours. Efficacious in checking 
the diarrhoea of children. 

Tannin and Nitric Acid. 

Take thirty grains of tannic acid ; one drachm of nitric acid ; 
tincture of cinchona compound, four ounces ; water, four ounces : 
mix. Take a tablespoonful repeatedly. A good way to give tan- 
nin, so as to check the destructive ulceration of senile bronchitis. 

Aromatic Sulphuric Acid. 

Aromatic sulphuric acid, one ounce ; cinnamon-water, four 
ounces : mix. Teaspoonful doses. Invaluable for all hemorrhages. 

Sulphuric Acid, Turpentine, and Alcohol. 

Take chemically pure sulphuric acid, half an ounce ; oil of 
turpentine, one ounce ; alcohol, an ounce : mix and shake well. 
Dose, from five to ten up to fifteen drops, in water, as often as 
indicated. Will often control the most profuse and violent forms of 
uterine haemorrhage and bleeding from lungs. 

Turpentine. 

Take spirits of turpentine, two drachms ; mucilage of gum 
arabic, one ounce ; oil of peppermint, thirty drops : mix. Ad- 
minister in teaspoonful doses. Often useful in typhoid fever. 

Gallic Acid. 

Gallic acid, ten to fifteen grains, dissolved in a little port 
wine : given at a dose, and repeat. A valuable astringent in 
hsernorrhage from the lungs, stomach, intestines, or kidneys. 

Nitric Acid. 

Take of dilute nitric acid, two drachms ; tincture of cinna- 
mon, six drachms : mix. Give thirty drops in a wineglassful 
of water, every two hours. Useful in hemorrhage from the kid- 
neys, bladder, uterus. 

Alum and Sulphuric Acid. 

Dissolve as much pulverized alum as possible in a tumbler- 
ful of water, of which take two tablespoonfuls every two hours, 
and before taking, add to each dose fifteen drops of aromatic 
sulphuric acid. Very good in all haemorrhages. 

Perchloride of Iron, 

Take fifteen drops of perchloride of iron, add to one ounce 
of sweetened water; then add six drops of dilute muriatic acid : 
mix, and take at a dose, and repeat if necessary. Good in all 
haemorrhages. 



808 REMEDIAL AGENTS. 

Tannin and Opium, 

Take ten grains of tannin ; ten of pulverized opium ; add a 
few drops of cinnamon- water, to make a mass; then divide into 
fifteen pills, and take one after every motion of the bowels, 
when they exceed one per day. Excellent in chronic diarrhoea. 

Other Astringents, 

As infusions of matico, logwood, sumach. 

Bayberry and Poplar Bark. 

Take a tablespoonful of pulverized bayberry, same of poplar 
bark, and half a teaspoonful of cayenne pepper ; infuse in half 
a pint of boiling water ; cool. A wineglassfull every hour, in 
diarrhoea. 

Heat and Cold as Astringents. 

The vitalizing action of heat induces tonicity of the nerves 
and contraction of the vessels ; hence, hot water in the vagina 
or rectum, in uterine haemorrhage, is more valuable than cold. 
Cold, or ice, in some instances, is not procurable or convenient 
of application, and then we have recourse to freezing mixtures, 
which may be made of equal parts of ice and common salt, or 
the following: 

Mixture. Parts. Temperature. 

Snow or ice,. . . . 12 ) 

Common salt, . . . . 6 VFrom 18° to 25° Fahr. 

Nitrate of ammonia, . . Q ) 

Muriate of ammonia, . . 12 

Saltpetre, . . . . 12 , ar zero 

Nitrate of ammonia, . 

Common salt and water, . 

Aromatic Syrup of Blackberry. 

Take of blackberry juice two pints ; sugar, one pound ; brandy, 
one pint ; six grated nutmegs ; pulverized cinnamon, half an, 
ounce ; cloves and allspice, of each a quarter of an ounce : mix. 
Dose, from one to two tablespoonfuls, every two or three hours, 
in diarrhoea. 

Rhubarb and Potassa. 

Take of fine Turkey rhubarb, pulverized, one ounce ; car- 
bonate of potassa, half an ounce; golden seal and bayberry, 
of each one-quarter of an ounce; cinnamon, half an ounce; 
pulverized sugar, one ounce; oil of peppermint, twenty drops: 
mix. One-half, or a teaspoonful dissolved in a cup of tea or 
coffee, is of the greatest utility in diarrhoea, caused by some indigesti- 
ble substance in stomach and bowels. 

Neutralizing Mixture. 

Powdered rhubarb, half an ounce; saleratus, half an ounce; 



REMEDIAL AGENTS. 809 

powdered peppermint-plant, half an ounce ; aniseed, half an 
ounce. Pour on the whole one pint of boiling water, and let 
it infuse over night, so that it will be reduced to a little over 
half a pint of liquid, when strained off. Add to the mixture 
one ounce of the fluid extract of bayberry, and add sugar 
enough to make a syrup. A most excellent combination in all 
affections of the bowels, especially ivhen loose. 

For Diarrhoea. 

Take of tincture of opium, spirits of camphor, essence of pep- 
permint, tincture of capsicum, of each half an ounce ; fluid ex- 
tract of bayberry and neutralizing mixture, two ounces ; brandy, 
three ounces. Dose, from a teaspoonful to a tablespoonful as 
often as indicated. An excellent combination. Or, 

Take subnitrate of bismuth, lactopeptine, of each one tea- 
spoonful; pulverized opium, ten grains: mix. Make twenty 
powders ; one after every movement of the bowels, when they 
exceed one per day. Or, 

Take syrup of rhubarb and potassa, four ounces ; tincture of 
catechu, one teaspoonful; mix. One teaspoonful thrice daily. Or, 

Take fluid extract geranium; fluid extract coto bark; fluid 
extract pipsissewa; of each, one ounce; simple syrup, three 
ounces : mix. Dose, one teaspoonful every hour. 

For Gonorrhoea. 

Take one pound of pulverized cubebs ; a quarter of a pound 
of alum; a quarter of a pound of bicarbonate soda; and half 
a pound of pulverized cinnamon : mix. Dose, one or two table- 
spoonfuls every three hours. Valuable in gonorrhoea, or gleet. 

Blackberry Cordial. 

To one quart of blackberry juice add one pound of white 
sugar; two tablespoonfuls of pulverized cloves; same of cinna- 
mon, allspice, and nutmeg. Boil all together for fifteen min- 
utes, and when cold, add a quarter of a pint of Jamaica rum. 
Bottle, cork tightly, and seal. Dose is a wine-glassful three or 
four times a day. Most useful in summer diarrhoea. 

Cholera Mixture. 

Take essence of ginger; camphorated tincture of opium; 
aromatic spirits of ammonia ; spirits of camphor ; tincture of 
capsicum ; of each, one ounce ; oil of cloves and peppermint, 
half a drachm : mix well. Dose, from half to a tablespoonful 
every few minutes till relief is obtained. 

Or take one ounce of the tincture of camphor ; one ounce of 
tincture of rhubarb, and one ounce of the tincture of opium : 
mix all. Dose from twenty to thirty drops every fifteen min- 
utes, till relief is obtained. 



810 REMEDIAL AGENT8. 

BATHS. 

The ablution of the entire body once every twenty -four hours 
is an indispensable requisite to good health. This is to be done 
for ordinary cleanliness, to remove effete or waste matter, dis- 
ease-germs, stimulate the capillaries and the nerves of the skin, 
aerate the blood. Tepid, soft, or alkaline water is to be preferred. 

In acute disease, the entire surface of the body should be 
sponged twice or thrice daily, for the purpose of removing the 
great waste, opening the pores, and diminishing heat, pulse, and 
respiration. These frequent spongings are in all cases to be 
followed by drying off well, and then rubbing with the dry 
hand. In such diseases as scarlatina or small-pox, we can- 
not carry this out, but then we can brush them over with 
sweet olive oil ; castile soap and warm water first. Sometimes 
it is very cooling and refreshing to follow with warm vinegar 
and water, or bay rum, and if there is great wasting, rub in 
as much warm olive oil as the skin will absorb after the even- 
ing bath. There are some conditions, or exceptions, to bathing, 
such as patient's suffering from fractures, haemorrhages, or other 
affections, in which he should not be disturbed. 

Temperature of Baths. 

The cold water bath, 33° to 65° F., simple or medicated. 
" cool " 65° to 75° F., 

" temperate " 75° to 85° F., 

" tepid " 85° to 92° F., 

" warm " 92° to 98° F., 

" hot " 98° to 110° F., 

Alkaline Baths. 

Carbonate of soda (common washing soda), one pound to 
thirty gallons of water, temperature to suit — generally tepid. 
Besides being essential to good health, it is of great use in the lithic 
acid diathesis, chronic rheumatism, and scaly skin disease. 

Acid Baths — Nitromuriatic Acid. 

Although the cuticle, or outside skin of the body, is like a 
rind, impermeable, still, by the aid of tepid water, it becomes 
relaxed sufficiently for medicated fluids to penetrate ; so that, 
if we add about half a pound of nitromuriatic acid to thirty 
gallons of tepid water in a wooden bath-tub, and let the patient 
lie in it about twent} r or thirty minutes, we have it taken up 
into the blood, and obtain its action on the liver. Very useful 
in liver disease. 

The Bran Bath. 

Thirty gallons of tepid or warm water ; one pound of ordinary 
washing soda, and several quarts of bran. The wheaten phos- 



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REMEDIAL AGENTS. 811 

phates are to be rubbed over any parts of the skin that are 
roughened, inflamed, or diseased. A very valuable bath in all 
scaly affections of the skin. 

Iodine Baths. 

Thirty gallons of tepid water ; one pound of washing soda ; 
iodine or tincture of iodide, enough to slightly stain the skin ; 
smaller quantities can be made for local baths. The combina- 
tion of iodine, iodide of potass, and liquor potass can be used, 
but it is too expensive ; the former is cheap, and equally effica- 
cious. Remain in it at least half an hour, or longer. Used 
with marvelous success in tuberculse, syphilis, parasitic shin diseases, 
and in chronic disease generally. 

Salt Water Baths, 

Take the above iodine-bath, and add to it one or more pounds 
of common rock salt, and lie immersed in it half an hour. In 
it we have the iodine, which is really the chief agent in sea- 
bathing. 

The common salt water bath is made by adding half a pound 
of bay salt to four gallons of warm water, and the entire body, 
except the hairy portions, sponged with it every morning. The 
surface of the body, before using, should be sponged off with a 
little hartshorn and water, thoroughly rubbed, or shampooed, 
or massaged ; the flesh-brush or Turkish towel used actively 
for a few minutes, and then the salt water sponged on part by 
part. Uusful in general debility. 

Sulphur Bath, 

Take one pound of sulphuret of potassium, and one pound 
of washing soda, and add to thirty gallons of water, comfort- 
ably warm, in a wooden bath-tub ; lie immersed in it from 
thirty to forty-five minutes. The tub can be covered with oil- 
cloth, all but the face, as the odor is often unpleasant ; smaller 
quantities can be made for local baths. This bath is invaluable 
in lead, mercurial, or other poisoning ; in paralysis from lead, lead 
colic, syphilitic disease of the skin, and in destroying disease- germs, 
as scabies, barber's itch, chloasma, etc. 

Borax Bath. 

Take one pound of borax, one pound of washing soda, to 
thirty gallons of tepid water, or even half the quantity of the 
borax and soda, if the skin is soft. Use as a bath in scaly, para- 
sitic, and irritable diseases of the skin. Borax being a parasiticide, 
like sulphur, is an excellent agent for healthy as well as diseased 
cuticles, and should be generally used in all forms of alkaline bathing. 

Conium and Starch Bath. 

The conium-bath is made thus : In thirty gallons of warm 



812 REMEDIAL AGENTS. 

or tepid water, add two handfuls of conium leaves, or an ounce 
of the solid extract; add, also, one pound of starch, properly 
cooked, to the bath. Cover the bath with oil-cloths, leaving 
the head bare, so that the conium be not inhaled, as it often 
gives rise to headache, if not so guarded. Remain in bath at 
least half an hour. Most excellent in eczema; allays that intolerable 
itching in the skinin prurigo ; relieves soreness, also operates favor- 
ably in rheumatic pain; acts promptly. 

A simple starch-bath, either alone, or with borax, without 
conium, is very soothing on inflamed skin. 

Various Other Baths. 

Baths medicated with creosote, carbolic acid, sulphate of iron, 
oak bark, pine, witch-hazel, arsenite of soda, etc., are of very 
little utility because their astringent action prevents them pene- 
trating inwards. They are simply novelties in baths. 

Gelatine Bath. 

Melt one pound of good, white, cabinet-makers' glue, and 
add it to twenty gallons of warm water, in which two quarts 
of bran has been immersed in a bag. It is extremely efficacious 
in eczema, and all irritable affections of the skin. 

Alcoholic Vapor Bath, 

This is the most accessible, and for general utility, one of the 
best forms of bathing, and every family should be familiar 
with its use. In the first place any tinsmith will make a con- 
venient lamp, like an oyster chafing-dish, with five wicks, each 
the thickness of a quill, and large enough to hold alcohol to 
burn three-quarters of an hour. In the centre, over the five 
flames, a deep plate, large enough to hold water to boil for 
forty-five minutes. The whole, for safety, might be placed in- 
side of an iron pot, which is to be placed underneath the chair 
on which the patient is to sit. The patient is then to be divested 
of ail clothes, and sit down on the chair under which the spirit- 
lamp is placed. This chair must have a thick, wooden bottom, 
and there must be some protection, either a piece of wood, or 
blanket, placed in front to prevent undue heat on his calves. 
The patient, sitting down, must be carefully enveloped in 
blankets pinned tightly around his neck, and laying on the 
floor, and be careful that no crevice, or hole, or outlet exists to 
let the vapor escape. The patient being thus duly enveloped 
and covered up, the lamp and saucer which had been pre- 
viously fixed, the former with alcohol, and the latter with water, 
the five wicks are ignited. In a few minutes he begins to ex- 
perience the glow of the burning alcohol, and by and by the 
steam begins to rise. Some recommend giving a cup of hot 
boneset, or pleurisy-root tea, but it is unnecessary — the best 



REMEDIAL AGENTS. 813 

drink is abundance of cold water. With this bath there is a de- 
termination of blood to the skin ; it relieves cerebral, lung, and 
visceral congestion ; induces a healthy action of the skin and 
mucous membrane; eliminates noxious matter from the blood, 
and imparts a sense of elasticity and vigor to the system. It 
is useful in both health and disease, but especially in colds ; con- 
gestion of the lungs, liver, kidneys ; dropsy, gout, and rheuma- 
tism, neuralgia. No tendency to catch cold after it. It will 
break up all fevers. It should be given upon an empty stom- 
ach, and never to pregnant women, or those who are menstru- 
ating. It can also be used for medicated vapor baths, by adding 
iodine, or other chemical agents to the water in the saucer, so 
that the patient is exposed to the influence of three agents, 
heated air, or alcoholic vapor, steam, and the medicinal agent 
used. 

After one-half, or three-quarters of an hour in this bath, with 
copious perspiration, the light should be extinguished, and the 
blankets pushed down, the body well rubbed and dried, and 
then the lower half; a dry shirt put on, and place in bed for 
several hours, or over night. It is much superior to either the 
Turkish or the Russian bath, and costs little. No family 
should be without it. 

The Turkish and Russian Bath. 

The Turkish bath and Russian bath are of utility, but do not 
excel the above ; they are apt to cause a determination of blood 
to the head, and the brain is liable to suffer. They are injurious 
when there is any obstruction to the circulation, or when the 
muscular fibre is weakened by tobacco, or when the heart or 
vessels are affected with fatty degeneration, or when there is 
any disease of the nerve-centres. 

Mustard Foot-Bath, 

Put a handful of mustard in a pail of hot water with several 
large lumps of washing-soda. Place feet in it as hot as can be 
borne, for fifteen or twenty minutes. Valuable in congestion of 
the head, chest, suppression of the menses, etc. 

The Shower Bath ; or, Cold Affusion. 

Seat the patient in an empty bath-tub, and take two large 
watering cans, one filled with cold water, 40° F. ; the other with 
tepid water. First pour from a height of several feet, the cold, 
on chest, face, and back; then take the other can. and run the 
warm water in the same way ; then the cold and hot altern- 
ately, or dash buckets of water in the same manner. The hot 
and cold water alternately produces the best reaction — it arrests 
irritability, lowers the temperature, lessens the frequency of the 
pulse and respirations. Best adapted for men. 



814 REMEDIAL AGENTS. 

The Shallow Bath. 

Patient is made to sit in a bath, with a depth of water of 
twelve inches, while water is gently poured over the head, and 
then rubbed and dried, and again douched ; and so on for half 
a dozen of times. The water is best cold. As a substitute for 
this, a sheet dripping out of cold water should be applied to 
the body, over which rubbing, massage, should be performed ; 
then a dry sheet substituted for the wet one, and the same pro- 
cess repeated. 

Wet Sheet ; or, Blanket Packing. 

The enveloping of the entire body in a wet sheet, blanket, or 
other agent, is of the greatest utility ; but is best suited for 
hospital practice, where it can be carefully watched by the phy- 
sician in charge. Its utility in all fevers is decided, and for sun- 
stroke, nothing can equal it. 

The Warm Bath and Acid Sponging. 

The warm bath is very sedative, especially when the system 
is irritable and heat is high ; and should, if possible, be used in 
fevers, inflammations, and acute rheumatism. If patient is 
unable to get to the bath, the ordinary sponging should be car- 
ried out. The change from alkaline to acid sponging is often 
grateful to the patient. 

Iodine Bath, 

Iodine bath should contain half a grain of iodine to each 
quart of warm water ; and for an adult, one drachm to twenty- 
five gallons. 

Refreshing Bath. 

In all diseases the skin should be sponged off with tepid 
water and castile-soap three times a day. To the water so used, 
add a tablespoonful of the following mixture : To one quart 
of alcohol add one teaspoonful of oil of lavender ; one teaspoon- 
ful of oil of bergamot ; one teaspoonful of oil of lemon, and one 
of oil of cinnamon. The addition of this makes it most refreshing. 

Puff Powders ; or, Skin Enamel. 

Take half a grain of carmine ; one drachm of nitrate of bis- 
muth ; one drachm of camphor ; two drops of the oil of bitter 
almonds, and two ounces of starch. Mix into a fine powder. 
Or, take half a grain of carmine ; one drachm of the white oxide 
of zinc; one drachm of camphor; one drop of otto of roses; 
and two ounces of starch : mix. Make into a fine powder. 
Both are to be used for dusting on the skin. Valuable in chaf- 
ing, or to cool the surface in the heats of the change of life ; also, for 
tender parts, or excoriations. Makes an excellent face powder ; 
makes the skin have an enamelled appearance. 



KEMEDIAL AGENTS. 815 

ELECTRICITY. 

This agent is to be regarded as a nerve stimulant and tonic 
of a very powerful kind, exercising in all cases an effect on the 
general nutrition of the part. 

This agent is used in three forms : 

(1.) That of quantity : Produced by chemical action, and ob- 
tained directly from a battery, regulated by the number and 
size of its cells, and called the continuous, voltaic, or galvanic 
current. 

(2.) That of intensity : Produced by induction, either from a 
magnet or galvanic current, by long coils of insulated wire, and 
called the induced, Faradic, or interrupted current, or magnetic 
electricity. 

(3.) That of highest intensity: Produced by friction on an 
electro-negative substance, called static, or frictional electricity. 

The two first are generally used, and the difference in action 
of the induced and continuous currents are due to— 

The very high tension of the induced current enables it to 
overcome great resistance, and reach deep-seated muscles and 
nerves. 

The greater quantity of the continuous current gives it more 
chemical power, decidedly affects nutrition by its action on 
minute vessels, and induces action which produces tissue-change. 

The direction of the continuous current is uniform ; the in- 
duced current changes constantly. 

The continuous current flows in a regular stream as long as 
contact is maintained and chemical supply kept up. Passed 
through a group of healthy muscles, they make strong and 
protracted contractions. Electricity should never be applied 
to the human body heedlessly, nor carelessly, nor by a person 
not fully posted in its application, nor by any one not thor- 
oughly familiar with the muscles and nerves of the body and 
with disease. 

There is often a remarkable idiosyncrasy in some persons to 
the application of the remedy, and great care should be exer- 
cised in its use, especially about brain or cord. 

Galvanism, or the continuous current, is rarely applied with- 
out intermission, which can be obtained by one of the conductors 
from the skin. The intensity of a single cell, unless very large, 
is insufficient to overcome the bad conducting power of the 
human body; therefore, when applying currents direct, many 
cells are usually used ; as many as from forty to sixty should be 
contained in an apparatus intended for a variety of diseases. 

For family use, the Faradic or magneto-electrical machine, 
with one or two cups, is sufficient. 

The usual methods of applying electricity are direct and indi- 
rect localized electrization. In the former, the current bearers, 



816 REMEDIAL AGENTS. 

or poles, are placed directly on a muscle, or organ, to be Fara- 
dized or galvanized ; in the latter, two points in the course of 
a nerve are selected for the poles, and the current is made to 
affect the part supplied by the nerve. 

The poles of the battery should be encased in sponges, which 
should be taken off after every application, well cleansed and 
disinfected with weak muriatic acid water, so as to prevent 
disease-germs from being carried from one patient to the other 
during the treatment. The sponges should be kept moist with 
salt water, so as to carry the electricity away down into deep 
parts. 

In its application, when we desire to soothe, stimulate, increase 
nerve-force, circulation, we apply positive pole to the origin of 
the nerve, or the part nearest its origin, and the negative to the 
other end. This excites healthy nutrition, with alkaline secre- 
tion ; if the currents are reversed, negative to the origin and 
the positive to the other end, it irritates and produces an acid 
secretion. 

The process of application in nearly all cases is much benefited 
with abundance of kneading, shampooing, or massage. 

An electrician should be free from tubercle syphilis, cancer, 
and other disease-germs ; because, if so affected, he will commu- 
nicate them to the patient by the following, which is a comnon 
method of manipulation : Place patient's feet on a sheet of 
copper, or his buttocks on a metallic chair connected with the 
negative pole, while the operator holds the positive pole in a 
moistened sponge in his left hand, while with the right he 
manipulates the body. 

No uneducated person should use this remedy indiscrimi- 
nately. The highest skill and great experience are necessary 
in its use, especially about nerve-centres, in nervous exhaustion, 
anaemia of brain and cord, epilepsy, softening, melancholia, 
paralysis of cerebral origin, etc. 

It is of great value in lead and mercurial paralysis, aided with 
alteratives, and iodide of potass, and sulphureted potass baths ; 
facial paralysis, aphonia, paralysis of vocal cords, of bladder, 
of bowels ; very great utility in constipation, inertia of liver, 
impotency, want of erectile power, progressive muscular atro- 
phv, locomotor ataxia, chorea; palsy from overwork, such as 
we meet with in writers, needle- women, dish-washers, and also 
in shaking palsy. Cases are recorded where it is said to have 
cured tetanus and hydrophobia, but this is very doubtful. 

Aneurism and Nsevus. — The introduction of one or more 
needles into the cavity of those blood-sacs, coagulates their 
contents at the negative pole. Some introduce the needles 
attached to both poles ; others, simply the negative, with the 
positive sponge externally. 



REMEDIAL AGENTS. 817 

Asphyxia. — Place one pole on each side of the neck below 
the ear, so as to affect the phrenic nerve; use artificial respira- 
tion ; if that fail, put one pole (positive) to nape of neck, and 
other over origin of diaphragm, near the seventh intercostal 
space. 

Deafness and Tinnitus. — Fill ear with tepid water, and insert 
the positive pole, insulated only at tip ; place other on neck ; 
begin with weak current, and increase. Eye affection in same 
manner, by an eye fountain, negative pole to nape of neck. 

Internal tumors require great care lest irritation be produced, 
and growth increased. Then electrolysis is often successful. 

Diseases of Women. — In amenorrhcea : One pole placed over 
abdomen, the other on the lumbar spine ; or if case is stubborn, 
positive on lumbar spine ; negative attached to an insulated 
catheter, with bare tip in the uterus. 

Menorrhagia. — Positive over lumbar spine, or from hip to 
hip ; other over uterus or pubes. 

Uterine Inertia in Labor. — Pains short, feeble, and at long in- 
tervals. The pregnant uterus has strong motor points, and 
these are easily influenced by the application of the battery — 
positive to spine, negative over the uterus ; well marked, strong, 
long contractions take place. 

Relief of pain : strong current, and wire brush over affected 
part. 

Muscular Disease. — Massage, followed by Faradization of every 
part of the muscle, for one-half or three-quarters of an hour. 

Asthma. — A large number of cases of asthma are due to 
bronchial congestion, combined with muscular spasm, both of 
which are due to nervous disturbance in the vagus; and those 
disturbances may be induced reflexly by irritation of the various 
nerves distributed to the upper part of the respiratory tract. 
Apply both poles to the neck, under the lower jaw ; often affords 
relief. 

CAUSTICS. 

Caustics are a class of remedies intended to destroy the part 
with which they come in contact. 

Chromic Acid. 

Dissolve one drachm of chromic acid in three drachms of 
water. Excellent to destroy warts. 

Chloride of Zinc. 

Take of chloride of zinc, chloride of bromine, chloride of gold, 
and chloride of antimony, equal parts. Mix into a paste of suf- 
ficient thickness with flour. Applied over cancerous growths, it 
instantly destroys them. Or, 



64 



818 REMEDIAL AGENTS. 

Chloride of zinc, blood root, equal parts ; with water and flour 
to make paste. Same as the above. 

Supersulphate of Zinc. 

Take half a fluid ounce of sulphuric acid, and saturate with 
the sulphate of zinc. This forms a paste, which can be lifted 
on the point of a pen, and drawn round and round a tumor or 
across it ; eats through the skin in a few minutes. The fissures 
thus made are to be filled with the paste, renewing the scratch- 
ing and filling in with the paste every two days. In this way 
in a week or ten days, a large tumor can be removed without 
hemorrhage. It does not harden the parts, and there is no 
possible danger of hsemorrhage. It is a valuable caustic to remove 
tumors of the breast. 

Other Caustics. 

Other caustics, as caustic potassa, which deliquesce and spread, 
require great care and a free use of vinegar after their use. 

Nitric acid, sulphuric acid, muriatic acid, do not burn deeply, 
but are not liable to spread. 

Chloride of Chromium. 

Chloride of chromium is the most valuable of all caustics, 
being perfectly painless, and having the remarkable property of 
uniting with and destroying the cancer-germ. (See Ozonized 
C/doride of Chromium.) 

Cancer. 

Take a pound of fresh crushed root of blue flag ; the same of 
poke, and of red clover tops, and red oak bark. Mix together, 
and boil gently for twenty-four hours. Then strain and evapo- 
rate down to the consistency of molasses. In order to keep from 
molding, add one teaspoonful of chloroform to the pint. It is 
a useful agent to spread on leather and apply as a plaster for 
the removal of cancers. Very slow in its action, but not painful. 

Iodine. 

When it is desirable to apply iodine as a caustic, and do not 
wish to have its stain, add a few drops of liquid carbolic acid 
to the tincture of iodine about to be used, and it will not stain. 

COUGH REMEDIES, OR EXPECTORANTS. 

Medicines that increase the secretion from the mucous mem- 
brane of the bronchial tubes, or air-passages, and air-cells of 
the lungs, and facilitate its discharge, at the same time soothe 
and allay the cough. 

Sweet Oil, Lemon Juice, and Sugar. 

Take one ounce of sweet olive oil, one ounce of lemon-juice, 
and one ounce of fine white sugar; beat or shake into a pulp; 



REMEDIAL AGENTS. 819 

put into a teacup, cover, and place on stove, so as to thoroughly 
dissolve the sugar. Give from a half to a teaspoonful quite 
often, till relieved. Extremely efficacious in coughs and colds oj 
children. 

Onion Syrup. 

Peel one or two red onions, chop up fine, and place in a 
saucer ; cover with an amount of sugar equal in bulk. Cover 
with a teacup, place on stove, or in oven, until all has dissolved 
into a syrupy mass. Any piece of onion not entirely dissolved, 
remove. Give half a teaspoonful very frequently, if bowels are 
not loose ; if loose, more gradually. It is of great utility in the 
colds and catarrhs of children. 

Infusion of Lobelia. 

Take a heaped teaspoonful of pulverized green lobelia — the 
plant, no seeds ; put in a teacup, and fill up with boiling water. 
It can be sweetened with sugar or honey. Give half a teaspoon- 
ful to a whole teaspoonful every hour or two, or more frequent, 
in infantile catarrh, so as to cause the phlegm to come up easy ; 
and morning and night one teaspoonful, one after another, till 
it vomits freely. Infants and young children swallow their 
expectoration, which is full of bacteria, and gives rise to hectic 
fever, hence the propriety of thus causing them to vomit. The 
shape and vertical position of a child's stomach enables it to 
vomit easily. Decidedly one of the most useful remedies in in- 
fantile catarrh, and fever of young children arising from exposure 
to cold. 

Bloodroot, Acetic Syrup, 

Put three ounces of bloodroot, crushed or pulverized, to steep 
in half a pint of good cider vinegar for two weeks ; then strain 
off through fine muslin ; then add to the half- pint about one 
and a half pounds of sugar, and boil down about one-third. 
This should be kept in every family. One of the very best remedie s 
for pseudo-membranous croup, as it destroys the membrane as fas 
as it forms. Administer half-teaspoonful to one teaspoonful 
repeatedly, one following the other, until relief is obtained. 

Lobelia and Bloodroot. 

Lobelia and bloodroot may be made into a syrup, by taking 
four ounces of simple syrup, and adding half an ounce of fluid 
extract of lobelia, and the same quantity of fluid extract blood- 
root, mixing together. Dose will range from a few drops to 
half a teaspoonful, as needed, in colds, coughs, etc. 

Syrup Ipecac. 

Take one ounce of the syrup of ipecac, keep it in vest pocket, 
and when you feel a little tickling or disposition to cough, take 



820 REMEDIAL AGENTS. 

cork out of the bottle, and simply turn it up on tongue, so as 
just to taste the ipecac ; probably not over five or six drops on 
the tongue in all, but repeat often. In this way there is none 
placed upon the stomach to offend it. 

Ipecac, Tolu, Wild Cherry, Squills, Senega. 

Take one ounce each of the syrups of ipecac, tolu, wild cherry, 
squills, and senega ; add five grains of the sulphate of morphia : 
mix. Dose, one teaspoonful every four hours. Valuable in irri- 
tating, hacking cough. 

Squills and Muriate of Ammonia. 

Take four ounces syrup of squills, to which add two drachms 
of muriate of ammonia : mix. One teaspoonful every two hours. 
Exceedingly valuable in chronic bronchitis. 

Bromo-hydric Acid. 

Take of simple syrup, six ounces ; acid hydrobromici, one 
ounce. Take half a teaspoonful frequently, dissolved in a little 
water. Nothing can excel it in the cough of acute bronchitis with 
great headache. 

Muriate of Ammonia, etc. 

Take of muriate of ammonia, one ounce ; chlorate of potass, 
half an ounce ; alum, two teaspoonfuls ; capsicum, half a tea- 
spoon fal ; pulverized bloodroot, one teaspoonful ; gum arabic, 
one teaspoonlul. Add the whole to a half-pint infusion of 
squills or wild cherry, and add sugar to suit the taste. Dose, 
a teaspoonful every three hours, or more frequent. Very effica- 
cious in the cough of chronic bronchitis. 

Rosin Weed in Asthma. 

Take four ounces of the compound syrup of lobelia; one 
ounce of the bromide of potassa ; half an ounce of the chlorate 
of potassa ; half an ounce of the bromide of ammonium ; one 
ounce of the fluid extract of rosin weed ; half an ounce of the 
tincture of calabar bean : mix. Dose, from a half to one tea- 
spoonful, every three hours, in asthma. Very efficacious. 

To Sooth a Cough. 

Take thirty grains of camphor, pulverized ; capsicum, two or 
three grains ; sugar of milk, a drachm ; one grain of the sul- 
phate of morphia ; fiwe drops of the oil of peppermint : mix. 
Make into ten powders, and put up in tin-foil. One every hour 
till the cough has entirely ceased. 

Iceland Moss. 

Take half an ounce of Iceland moss, boil in a pint of water 
for fifteen minutes, strain by compression. To this any seda- 



REMEDIAL AGENTS. 821 

tive can be added ; or, it can be taken alone for a cougb, sweet- 
ened to suit. 

Syrup of Garlic. 

Cut up fine one ounce of garlic ; cover it with vinegar ; macer- 
ate a week, and then strain off. Make into a syrup. Excellent 
for bad colds in children. 

Excellent Cough Mixture. 

Take one large teaspoonful of balsam of Peru, one of tolu, 
and the same of Canada fir. Make them into an emulsion, 
with a sufficient quantity of mucilage of gum arabic ; then add 
aeetated syrup of blood root, one ounce ; and tincture of lobelia, 
half an ounce. After mixing them well together, add twelve 
ounces of the syrup of licorice. Dose, one teaspoonful quite 
often, till cough is allayed. 

For Irritative Cough. 

Take camphorated tincture of opium, fluid extract licorice, 
and alcohol, of each one ounce ; syrup of tolu, three ounces : 
mix. Dose, one teaspoonful repeatedly till cough ceases. 

For Bronchitis. 

Take four ounces of compound syrup of stillingia, and three 
drachms of chloride of ammonia : mix. Dose, one teaspoonful 
three times a day. Or, 

Take liquid pitch, one ounce ; balsam of tolu, one ounce ; 
oil of turpentine, thirty drops ; alcohol, and simple syrup, of 
each two ounces: mix. Dose, from a teaspoonful to a table- 
spoonful, as needed. Or, 

Take syrup tolu, syrup senega, and fluid extract verba santa, 
of each one ounce. Mix and give a teaspoolful as indicated. Or, 

Take one ounce of syrup senega ; two ounces syrup ipecac ; 
two teaspoonfuls of chloride of ammonia; and three ounces of 
compound syrup stillingia. Mix all together. Dose, a table- 
spoonful as required. 

For Asthma. 

Take tincture of lobelia, tincture of gelseminum, fluid extract 
sumbul, of each one ounce : mix. Give from ten to thirty drops, 
as indicated. Or, 

Take extract hyoscyamus, extract lobelia, extract grindelia 
robusta, an equal quantity of each : mix, and make into three- 
grain pills. Dose, one pill as often as required. Or, 

Take fluid extract of sumbul, one ounce ; simple syrup, two 
ounces; bromide potash, bromide sodium, bromide ammonium, 
of each, two drachms : mix. Dose, one teaspoonful, as required. 

Hoarhound Balsam. 

Dissolve two ounces each of the extract of hoarhound and 



822 REMEDIAL AGENTS. 

extract of licorice, in half a pint of hot water ; when cold, add 
one ounce of paregoric ; six ounces of the syrup of squills ; two 
ounces of the tincture of benzoin ; and ten ounces of honey : 
mix well, and strain through fine linen. Dose is a teaspoonful 
frequently. Very useful for coughs and colds. 

Cough Mixture. 

Take of bloodroot, slippery elm bark, coltsfoot, elecampane, 
spikenard, comfrey root, lobelia plant, snakeroot, of each one 
ounce ; infuse over night by pouring on the whole one quart of 
boiling water ; strain off in the morning, and add sugar to 
make a fine syrup. If this is not desired, then add an equal 
quantity of brandy to it, and let the patient take a tablespoon- 
ful every hour. One of the best combinations for a cough. 

DIAPHORETICS. 

Medicines that promote perspiration, open the pores of the 
skin, unload the sweat-ducts, remove constriction of the cuta- 
neous capillaries, deplete the blood of its water, cause a revulsion 
to the surface in a determination of blood, promote absorption, 
and eliminate morbid matter, or dead diseased germs, from the 
body. A valuable class of remedies. 

Ammonia. 

Liquor ammonia acetatis. Dose, one teaspoonful, in water, 
frequently. Excellent in tonsillitis, pneumonia. 

Dover's Powder. 

Take thirty grains of Dover's powder ; divide into six pow- 
ders. Take one every two hours in an infusion of pleurisy root 
or boneset tea. Stop their use when the patient is bathed with 
sweat, but continue the tea as a drink. Use whenever a gentle 
diaphoretic is indicated. 

Serpentaria Compound. 

Compound tincture of serpentaria. Dose from a half to a 
teaspoonful, in sweet marjoram tea ; administer frequently. Of 
great utility in measles, scarlatina, small-pox, and whenever a gentle 
diaphoretic is needed. 

Infusions of Asclepias. 

Boneset, crawly, sweet marjoram, mullein, one ounce of each 
to one pint of water, are excellent diaphoretics. Drink freely ; 
best warm. 

Balm Tea. 

Balm leaves, one ounce; one heaped tablespoonful of sugar; 
lemon juice, one ounce; infuse in one pint of boiling water for 
twenty minutes. This forms a useful drink in colds to get up 



REMEDIAL AGENTS. 823 

a gentle perspiration ; best to be drank warm before retiring 
to bed. Or, 

Infuse one ounce of balm leaves, elder flowers, marsh mallow, 
spearmint, and arnica flowers, with half an ounce of anise seed, 
in boiling water. 

Sweating Drops. 

Take one-fourth of an ounce of camphor, saffron, ipecacuanha, 
opium, and Virginia snakeroot ; Holland gin, three-fourths of 
a pint ; let them steep for seven days. Dose, ten to twenty or 
thirty drops, repeated until free perspiration takes place. The 
bowels are best to be moved before its exhibition. It has great 
efficacy in breaking up fevers, colds, rheumatic attacks, congestive 
chills etc. 

Sweating Powder, 

Take one ounce of pleurisy root ; one ounce of boneset ; one 
ounce of crawley root ; half an ounce of lobelia herb, and the 
same of skunk cabbage ; powder very fine, mix them together, 
and keep them in a stoppered bottle. Dose, from one-fourth to 
one-half teaspoonful in warm tea, and repeat dose every hour 
till free perspiration is induced. In fevers, inflammations, influ- 
enza, pleurisy, colds, this powder is invaluable. It subdues irri- 
tation, relieves difficult breathing, lowers the pulse, gives rise 
to free perspiration, and promotes sound sleep. If given early, 
it will arrest lung fever. 

Jaborandi. 

This is the prince of all diaphoretics, possessing most extraor- 
dinary properties in its action upon the skin, whose action it 
entirely revolutionizes, even rousing into action the matrix of 
the hair on that gland. The fluid extract is the best form for 
administration, in from twenty to sixty drops, repeated as indi- 
cated. With this remedy the patient must not drink, and as 
fast as the saliva accumulates in the mouth, it should be spat 
out, not swallowed. Its action is unfailing, very positive in 
causing the most drastic, copious perspiration. It is of great 
utility in all fevers, pneumonia, nleurisy, peritonitis, Bright's 
disease, acute rheumatism, bronchitis, etc. Its alkaloid, pilo- 
pine, in one-fourth or one-third of a grain dose, is even more 
powerful, breaking up attacks of asthma, and inducing perspir- 
ation at once. 

Some claim that pilocarpine will produce a luxurious growth 
of the hair, and also change its color from a blonde to a deep- 
black. We have used the drug, both by the stomach and skin 
(hypodermically), and have failed to detect such a phenomenon. 
It operates well in rousing up the secretion of milk, when fennel 
seed, and castor oil, and calabar bean, even, fail. 



824 



REMEDIAL AGENTS. 



Sage, Rue, and Balm Teas. 

Those three garden herbs, if made into a tea and adminis- 
tered, will produce perspiration, or sweating. They are invalu- 
able in fevers; to flavor, a little lemon juice can be added. 

Sweating Powder. 

Take one teaspoonful of pulverized ipecac, same of opium, 
wild turnip, skunk cabbage, and cayenne pepper : mix. Dose, 
quarter of a teaspoonful every two or three hours. Of great 
utility in colds, coughs, congestion of lungs, and diffiadty of 
breathing. 

DIFFUSIBLE STIMULANTS. 

Diffusible stimulants excite the circulation, have no influence 
on the nervous system, but are invaluable in all states of pros- 
tration or collapse, when the system is shocked or devitalized. 
They simply aid a renewal of life in shattered, or debilitated 
states of the system. 

Brandy. 

This is a diffusible stimulant, and should be given in table- 
spoonful doses, alone, or with water, or white of egg, frequently 
repeated — that is, every few minutes, until the result is obtained 
— increased or diminished heat, pulse and respirations. 

Capsicum. 

An excellent, diffusible stimulant. The common powder, 
added in suitable quantities, to warm sweet milk, and drunk 
freely ; the compound tincture of myrrh, or No. 6, added to 
good, strong, hot coffee. Those are two elegant forms of admin- 
istration. Still it may be given with best success in any form. 
A remedy of great value in prostration, lingering labor, paralysis, 
exhaustion. 

Administer at suitable intervals and proper doses, from half 
to a teaspoonful to half a pint of warm milk; a wineglassful every 
little while, or, if No. 6 : a teaspoonful to a teacupful of hot 
coffee, thrice daily, or more frequent. 

Ammonia. 

The aromatic spirits of ammonia is probably the best form 
for administration — small doses frequently repeated, say ten to 
thirty drops, in water ; carbonate of ammonia in from five to 
ten grains, at proper intervals apart. 

Prickly Ash. 

The prickly ash, or the fluid extract of xanthoxylum, is a 
mild, but much over-rated, diffusible stimulant. It cannot be 
depended on in great emergencies, like capsicum. 



REMEDIAL AGENTS. 825 

Musk Root. 

This is an elegant remedy. It can be administered freely 
in hot tea. 

Quinine, 

Quinine with phosphate of ammonia makes an excellent stimu- 
lant. 

Cajeput Oil and Cloves. 

Two or three drops of each beat into an emulsion, with sugar, 
and swallowed either in a capsule or in a piece of jelly. A good 
stimulant for colic. 

Chloroform. 

A few drops of chloroform in water is more reliable. 

Hot Drops. 

Take two ounces of gum myrrh ; one ounce of capsicum ; 
and two ounces of peach kernels, and add the whole to one 
pint of alcohol. Let it steep for two weeks. Dose, a teaspoon- 
ful in a little warm tea, three times a day. It makes a good 
local application in any painful affection. Good for bruises, 
sprains, stiff joints. 

Composition Powder. 

Take two pounds of finely pnlverized bayberry bark ; one 
pound of hemlock bark ; one pound of ginger ; two ounces of 
cayenne pepper, and two ounces of cloves. Mix them together. 
Put from one-half to a teaspoonful in a cup of boiling water ; 
sweeten if desired, and as soon as cold, drink the contents. An 
excellent remedy in weak stomach and dyspepsia. 

For Intoxication. 

Take two ounces of tincture of valerian ; two ounces of 
aromatic spirits of ammonia; two ounces of fluid extract of 
skullcap ; two ounces of tincture of capsicum : mix. One table- 
spoonful frequently. Excellent in habitual inebriation. 

The same could be improved by the addition of coca and 
musk-root. 

For cheapness, the tincture of the valieranate of ammonia 
and capsicum, in an infusion of skullcap, make an excellent 
formula for steadying up the shattered nerves. 

For Bites of Rabid Animals, Venomous Reptiles, Insects, 

Ivy, Sumach. 

If there is a wound, the immediate treatment, in all cases, is 
as follows : A ligature to be applied on the cardiac side of the 
wound, to prevent absorption. The wounded, or bitten part, 
should be cupped, or incised, and free bleeding encouraged 
with hot water. Then the wound should, if large, be cauter- 



826 REMEDIAL AGENTS. 

ized with caustic potassa, and then vinegar applied freely to 
neutralize the action of the caustic; or, if small, it could be 
dressed with muriate of ammoniate; if the caustic is applied, 
follow with lobelia and linseed meal poultice ; if these means 
are not handy, don't wait, but chop up fine, either garlic or 
onions, and beat into a paste, with common salt, and apply a 
good thickness. Change every three hours. If it is simply an 
insect bite, or sumach, a saturated solution of muriate of am- 
monia, should be kept continually on the part, and kept wet. 
Of internal remedies, diffusible stimulants are the best: for 
the bites of animals, compound tincture of ammonia, or aroma- 
tic spirits of ammonia, in doses of two drachms to the ounce of 
water, repeated frequently ; and if it is a reptile, or snake, 
brandy is always about, and most reliable, but must be given 
in repeated doses, till intoxication is induced. For ivy and 
sumach, no internal remedies are needed, if the muriate' of 
ammonia is applied early. For scratches, abrasions, in teeth ex- 
tracting, the muriate of ammonia is excellent, but its antiseptic 
properties are greatly increased by adding tincture of iodine to it. 

Prickly Ash Berries. 

Either the juice of the root, or the prickly ash berries steeped 
in whisky, make an excellent diffusible stimulant. 

For Cramp Colic. 

Take one pint of alcohol; half an ounce of gum guaiac; a 
quarter of an ounce of gum camphor ; a quarter of an ounce 
of cayenne pepper: mix. Let it steep for two weeks, during 
which time shake once or twice daily ; then filter or strain. 
When filtered, add one ounce of chloroform. Very efficacious 
in cramps, internally and also locally. 

DIURETICS. 

Diuretics are remedies that increase the flow of the urine. 
They act in various ways. Alkaline diuretics wash out, flush 
the convoluted tubes of the kidneys ; astringents stimulate, but 
brace and tone ; others increase the solid constituents, etc. 

Sweet Spirits of Nitre. ( 

Ten to twenty drops in w T ater, or better still, in parsley-root 
tea. Operates well when the kidneys require stimulating. 

Infusions. 

Infusions of squills; broom-tops; parsley, both root and 
leaves; asparagus tops; juniper berries; buchu; uva ursi; 
queen of the meadow ; pariera brava ; cleavers ; are most relia- 
ble diuretics. As none are poisonous, take a handful, and pour 
on it a pint of water, and infuse over night, and drink freely 



REMEDIAL AGENTS. 827 

when cold. Cream of tartar and nitre can be added to them. 
They can be preserved by bottling up; and before corking, add 
half a teaspoonful of chloroform, to preserve them. The prac- 
tice of boiling asparagus, an excellent diuretic, and throwing 
out the water, is throwing away the gold and retaining the 
rubbish. It is like cooking fish in fat, which attracts all the 
phosphorus, leaving the fish a dry, non-nutritious mass. 

Digitalis. 

Have half a pint of water boiling briskly, and when so doing, 
add one or two grains of freshly pulverized digitalis leaves ; 
boil a few minutes ; then let it infuse half an hour, cool, strain. 
A wineglassful every two hours. Better to make fresh every 
morning. This is the great diuretic ; it prepares the kidneys 
for the evacuation of immense quantities of water. Its use, in 
from three to five days, must be followed with other diuretics, 
as buchu and cream of tartar ; squills and nitre. Infusion of 
digitalis is the ideal of perfection of a drug in all dropsies. 

Iron, Nitre. 

Take four ounces of camphor- water ; one ounce of tincture 
of iron ; and half an ounce of saltpetre : mix. A teaspoonful in 
water every three hours. In dropsy, with ansemia. 

Cream of Tartar and Cubebs, 

Take one ounce of pulverized cubebs, and one ounce of cream 
of tartar : mix. One teaspoonful every three hours in water, 
or gruel. Useful in dropsy, and also in gonorrhoea. 

Cider, Cream of Tartar, and Nitre. 

Take a pint of hard cider ; one ounce of cream of tartar ; 
and half an ounce of saltpetre: mix. Take a wineglassful 
morning and night, and oftener. Efficient diuretic ; use in all 
dropsies. 

Sulphur, Cream of Tartar, Gin. 

Take one pint of good Holland gin ; one ounce and a half of 
sulphur ; and one ounce of cream of tartar : mix. Shake well ; 
a small wineglassful morning and night. Very useful in drop- 
sies about the change of life, or ivhere there is suppression of the 
menses. 

Buchu, Uva Ursi, and Borax. 

Take a strong infusion of buchu and uva ursi — say, a pint ; 
take a wineglassful every three hours ; and just as about to 
take, add from ten to fifteen grains of pulverized borax to each 
wineglassful. If no rash comes out on the skin from the use 
of the borax, it may be continued ; but if the borax rash ap- 
pears, it must be diminished down to five grains. Very useful 
in catarrh of the bladder. 



828 KEMEDIAL AGENTS. 

Nitro-Glycerine. 

Make, or ask the druggist for, a one per cent, solution, which 
administer in obstructed kidney, or where it is caving-in in 
Bright's disease. It causes a disappearance of the albumen, and 
increases the flow of urine. Dose, seven to twenty drops every 
two hours. 

Balsam Copaiba and Cubebs, 
Take one ounce and a half of mucilage of gum arabic, to 
which add one ounce of balsam of copaiba ; one ounce of tinc- 
ture of cubebs; one ounce of fluid extract of kava kava; half 
an ounce of sweet spirits ; tincture of iodine and tincture of 
opium, half a drachm ; compound tincture of lavender, one 
ounce: mix. Dose, a teaspoonful, thrice daily, or every morning 
and night. Very excellent in catarrh of the bladder and gonorrhoea. 

Golden Tincture. 

Take one ounce each of gum myrrh, gum guaiacum, and 
balsam of tolu ; two ounces of balsam copaiba ; oil of hemlock, 
an ounce and a half; one ounce of wintergreen; one pint of 
alcohol, ninety-five per cent. : mix, and steep about two weeks. 
Dose, one teaspoonful twice or thrice daily. Invaluable in kidney 
affections; braces and astringes. 

Haircap Moss. 

Without a doubt, haircap moss is the great diuretic. It is 
more powerful and effectual than all known drugs. In its use 
in dropsy, there is no difficulty in the kidneys secreting from 
twenty to forty pounds of water in the twenty-four hours ; and, 
although they do that much work, they are toned and strength- 
ened thereby, as it astringes and braces like urva ursi, buchu, 
cleavers, and queen of the meadow. It is best used in the form 
of fluid extract; the dose being from one to two teaspoonfuls 
three times a day. Unexcelled in all dropsies. 

Couch Grass, Cleavers, and Uva Ursi. 

Make an infusion, by taking one ounce of each, and adding 
a quart of water, letting it infuse over night ; strain, and add 
half an ounce of sweet spirits of nitre. Before bottling, add 
half a teaspoonful of chloroform, to preserve. A wineglassful 
every three hours. Good where the kidneys are sluggish. 

Shepherd's Purse. 

A strong infusion is quite valuable in dropsy, especially in 
the abdominal form. 

Stoppage of Urine. 

Take green spearmint, blue flag, uva ursi, of each four ounces ; 
cover with Holland gin; steep two weeks, then strain. To each 



REMEDIAL AGENTS. 829 

half pint, add one ounce of sweet spirits of nitre, and one ounce 
tincture of green root gelseminum. One teaspoonful every three 
hours in stoppage of urine. 

EMETICS. 

Emetics are medicines which, when taken into the stomach, 
or applied to the skin, are taken up by the blood and nerves, 
and irritate the co-ordinating chemical centre at the base of 
the brain ; which irritation is carried by the pneumogastric, 
vagus, and other nerves, to the stomach, diaphragm, and ab- 
dominal muscles, which causes contractions of the stomach and 
evacuation of its contents. In addition to vomiting, they cause 
nausea, muscular relaxation, excite the functions of the liver, 
skin, and lungs, and often have a purgative action. Never to 
be given when there is acute inflammation of stomach, bowels, 
or peritonaeum, or where there is a determination of blood to 
the brain. In all cases their use should be preceded by copious 
alkaline drinks, so as to neutralize the acid condition of stom- 
ach, and permit of their rapid absorption and action. 

Wine of Ipecac. 

First, persuade patient to drink some warm fluid, as water 
and bicarbonate of soda — half a pint of the water to one tea- 
spoonful of the soda ; then administer a half teaspoonful of the 
wine of ipecac, and repeat every few minutes till free vomiting 
takes place. 

Syrup of Ipecac. 

Use in the same manner. 

Pulverized Mustard and Salt. 

Take one heaped teaspoonful of mustard and dissolve it care- 
fully in a little water, so that there will be no lumps ; then in- 
crease the water to half a tumblerful. Dissolve one tablespoon- 
ful of salt in a teacupful of tepid water, which drink at once, 
and in a few minutes follow with the mustard. 

The above three forms of emetics are very mild, well adapted 
for children, women, and elderly persons, and are useful when- 
ever we desire to remove the contents of the stomach. The 
quantity of each may be increased. If possible, get an abun- 
dance of warm fluid in the stomach before their administra- 
tion. 

Lobelia. 

Take one heaped teaspoonful of the pulverized plant (called 
green lobelia — no seeds) ; put in a teacup ; add a tablespoon ful 
of water, in which mix it thoroughly ; then fill up teacup with 
boiling water, and when cool enough to drink, begin its admin- 
istration ; but before, have the patient drink from half to a pint 



830 REMEDIAL AGENTS. 

of tepid water with a heaped teaspoonful of bicarbonate of soda 
dissolved in it. Begin the lobelia in this manner: First, a 
mouthful, which swallow ; in one or two minutes more, another 
swallow ; and so on until the entire teacupful is used. If, how- 
ever, the patient feels greatly nauseated and like to vomit, let 
him drink it down at one draught. More water with soda can 
be drunk, and more lobelia given, but the teaspoonful is usually 
enough. The efficacy of this emetic can be greatly increased 
by adding either a little composition powder, or bayberry, or 
capsicum ; or putting the lobelia into half a pint of boneset 
tea, instead of water, or any of those agents in infusion given 
freely to drink before giving the emetic. In cases of poisoning, 
pulverized animal charcoal should be administered freely be- 
sides the above. This is the most efficient of all emetics, indi- 
cated at the commencement of all fevers, disorders of the liver, 
and whenever an emetic is useful Has an excellent effect on 
the nervous system. 

Tincture of Lobelia. 

Never use that of the drug stores, as it is made from the 
lobelia seed, which is very dangerous to some persons. For 
domestic purposes, take two ounces of the seed and four of the 
plant, not pulverized ; put into a jar and cover with common 
whiskey (about a quart) ; cover carefully with a piece of bladder, 
and let it steep a month; then strain off, bottle, and label. 
When an emetic is required, administer either the tepid water 
and carbonate of soda, or the infusion of capsicum, composi- 
tion, bayberry, boneset, or some other tea, with the soda, as 
above ; then give this tincture in teaspoonful doses every five 
minutes, till free vomiting takes place. This is the very best 
method. Besides, the above makes a preparation that will 
readily keep twenty or thirty years, and all the time be grow- 
ing better. 

Compound Powder, or Tincture of Lobelia. 

Compound powder, or tincture of lobelia, which is made up 
of lobelia, bloodroot, skunk cabbage and capsicum, is some- 
times used as an emetic, but it makes a better antispasmodic. 
If used, give in same doses as the lobelia powder, or tincture. 
Or another method : Take one tablespoonful pulverized lobelia- 
seed ; same of the herb; same of the pulverized blood-root; 
and the same of ipecac. Mix thoroughly together. Give one 
teaspoonful every twenty minutes, patient drinking freely of 
tepid water with bicarbonate potassa. Keep along till patient 
vomits freely. This is invaluable for cleansing the stomach, 
imparting new life and vigor to the body. 

There are a large number of emetics, but for all practical 
use the above are sufficient ; kind and gentle in action, and re- 



KEMEDIAL AGENTS. 831 

liable ; whereas such remedies as antimony, copper, zinc, and 
tobacco, which are extensively prescribed, are dangerous in an 
extreme degree, and should not be administered. 

EMMENAGOGUES. 

Emmenagogues are a class of remedies that promote the 
menstrual function. Mostly all act through the circulation, 
and reflexly on the uterus. Some act by causing apoplexy of 
the uterine and rectal plexus of vessels ; others by stimulating 
the mucous coat of the uterus, while another class act on the 
brain and cord. In all cases they are best given a few days 
before the monthly period, and if the desired result is not ob- 
•tained at the regular time, leave them off till next period. They 
should never be given during pregnancy. 

Tansy. 

The oil of tansy, pennyroyal, sabinae, etc., are very dangerous 
drugs to use either in domestic practice or from the hands of 
a physician. So we do not endorse their use, on account of 
their toxical character. 

Parsley Root. 

Apiol, an extract from this root, is a gentle, safe emmenagogue. 
The dose is from five to ten grains three times daily. 

Compound Betin Pill Ozonized. 

This is the most reliable of all emmenagogue remedies. It 
never fails in its action, and should be generally used. (See 
Ozonized Remedies.) 

Acetic Tincture of Iron, 

In doses of half a teaspoonful thrice daily, in water, is very 
valuable in suppression of the menses, with anaemia. 

An excellent method of preparing an acetated tincture of 
iron is simply to take several pounds of ordinary lath nails ; 
cover them with good, sharp, cider vinegar ; then cover care- 
fully ; let them steep from two to four weeks. Filter through 
fine muslin ; bottle ; keep well-corked. Dose, one teaspoonful 
in water thrice daily. 

Borax and Sabinae. 

Take ten grains of pulverized borax and fifteen grains of 
pulverized sabina ; make into one powder, and take that quan- 
tity three times a day. Often useful, but the large dose of borax 
often causes a rash to appear on skin. This can, however, be 
prevented, by not using it over three days or so, before the period. 
In ordering it from the druggist, say one hundred grains of the 
borax and one hundred and fifty of the sabine,and when you get 
home divide it into ten powders, which are sufficient for the 
three days. 



832 REMEDIAL AGENTS. 

Cotton-Root Bark. 

The outer rind of the bark of the root of freshly dug cotton- 
root is a most reliable emmenagogue. The dry root and fluid 
extracts that we find in the northern drug stores are perfectly 
inert, and never should be used, as it is simply throwing money 
away. The root should be dug, washed, dried, the outer rind 
cut off and made into a strong tea, and drunk freely for a few 
days. The infusion can be preserved b}^ adding half a teaspoon- 
ful of chloroform to the pint. Its use should be stopped the 
moment the flow is perceived. 

Aloes, Macrotys. 

Take equal parts of the extracts (solid) of macrotys, sabinse, 
pulverized aloes and ergotine : mix. Divide into three grain 
pills. Dose, two three times a day. 

Take of macrotin,caulophyllum,socrotine, aloes, iodide potass, 
mandrake, equal parts: mix. Make into three-grain pills. Dose, 
two three times a day. 

Blue Cohosh. 

Take of the fluid extract of blue cohosh ; fluid extract ergo- 
tine ; fluid extract of water-pepper ; of each, one ounce ; then 
cut one drachm of the oil of sabinse in an ounce of alcohol at 
95 per cent.; shake well until the oil is thoroughly mixed; then 
add all together : mix. Dose, about half a teaspoonful thrice 
daily. 

Iron Pills. 

Take twelve grains of sulphate of iron ; six grains of pow- 
dered aloes; six grains of the extract of sabinse and twelve 
grains of white pine turpentine ; mix. Dose, one at bedtime. 
Or, take of sulphate of iron, twenty grains ; aloes, twenty grains ; 
extract of sabina, twenty grains ; powdered cloves, five grains ; 
Venice turpentine to make a mass, and divide into twenty pills. 
One pill three times a day. 

Aloes and Sabinse. 

Take one drachm of aloes ; pulverized sabina ; blue cohosh ; 
gum myrrh ; borax and pulverized tansy ; and add half an 
ounce of cayenne pepper: mix. Make into three-grain pills; 
one three times a day. If the bowels or liver are torpid, add 
the same amount of mandrake as the aloes. 

Baths. 

The Turkish, Russian, vapor, and ordinary warm baths are 
of great utility as emmenagogue remedies ; so is the hot mustard 
foot-bath, hip-bath, injecting vagina with hot water, and apply- 
ing mustard to the nipples to excite the activity of the uterus, 
especially when resorted to with the compound Betin pill. 



REMEDIAL AGENTS. 833 

ENEMATA. 

The act of throwing injections into the rectum, or lower 
bowel, to facilitate a passage of the bowels, increase the action 
of a cathartic, to get rid of great faecal accumulation, or to 
relieve the bowels in piles and enlarged prostate, is of great 
service. As regards the nutrition of the body by this means, 
little need be said ; the practice is altogether one in which gross 
ignorance and superstition are blended. The rectum is a mere 
receptacle for the waste matter, and has no lacteals to take up 
the blood elements to carry to the lymph canals for nutrition. 
Enemata, as a rule, should be emollient, consisting of beef tea, 
gruel, castor oil and glycerine, swett oil, etc. When used for 
constipation, to establish the law of habit, they should be em- 
ployed immediately after the morning meal, and may consist 
of plain cold water. If used during labor to relax the rigid os, 
or neck of the uterus, they should be warm, and contain lobelia 
and belladonna, 

Simple Enema. 

Take of common salt, one ounce ; barley-water or beef tea, 
half a pint. Good in constipation and seat-worms. 

Six ounces of warm olive oil; soft soap, and warm water; 
castor oil and infusion of rue ; laudanum and starch, one tea- 
spoonful to pint of liquid starch ; infusion of lobelia, in rigidhy 
of the neck of the uterus. 

Astringent Enema. 

Take half a pint of starch, thin enough to inject ; tincture 
of kino, half an ounce; laudanum, half a teaspoonful. Then 
add thirty drops of spirits of turpentine : mix. Give per rec- 
tum, twice in the twenty -four hours, in the diarrhoea of typhoid 
fever. 

Narcotic Enema. 

Take four ounces of liquid starch ; one teaspoonful of lau- 
danum; and fifteen drops of tincture of belladonna: mix. 
Administer to relieve a rigid os uteri, the pain of cancer of the 
uterus, etc. 

Turpentine Enema. 

Take of spirits of turpentine, half an ounce; mucilage of 
gum arabic, four ounces ; and add decoction of barley, two or 
three ounces : mix. Very useful in fits, suspended animation. 

Other Enema. 

Almost any infusion, or decoction, may be used, such as beef 
tea, for nutrition ; bayberry, for ulceration of rectum ; ivormwood, 
for pin- worms; oak bark, for falling of the rectum; chestnut 
leaves, for piles; and other remedies to meet special indications. 

65 



834 REMEDIAL AGENTS. 

When it is desirable that they be retained, let them be small, 
from one-half to a teacupful. 

FOMENTATIONS. 

Hot fomentations are of great utility in practice of medicine ; 
very useful applied to the shaved scalp in inflammation of the 
brain, in relieving the intolerable headache. Besides, they are 
often of great utility in arresting haemorrhage, and their ex- 
traordinary power is very marked when applied, scalding hot, 
over the heart in suspended animation from anaesthetics, even 
to vesication. Generally speaking, their efficacy depends greatly 
upon the presence of medicinal agents, as the addition of worm- 
wood to boiling water in fomenting the knee-joint in white 
swelling ; as oak bark, alum, and chamomile flowers, to weak- 
ened parts ; as infusion of hops in painful swellings ; as the 
infusion and fomentation of arnica flowers and marigold plant 
in black eyes, and other ecchymosis ; as infusion of poppies 
and elder flowers to sore eyes ; as the fomentation of the perin- 
seum in tardy labor with infusion of lobelia ; as the fomenta- 
tion of infusion of cayenne pepper and mustard in parts when 
a stimulant is required ; and so on with other remedies. In 
every process of fomentation there should be two flannels — one 
applied, the other soaked in the almost boiling fluid, which 
should be wrung out and applied as soon as the one that is 
applied has become cold. Heat applied in this manner is pro- 
ductive of vitality, promotes a renewal of life in the part to 
which it is applied, and by this action contractility of the weak- 
ened blood-vessels is induced, absorption of effused fluids pro- 
moted. Hot fomentations are of far greater efficacy in violent 
uterine haemorrhage than cold, and are now generally resorted 
to, as being more conducive to aid a renewal of vitality. 

GARGLES. 

Gargles are used either to allay irritation, or heal ulceration, 
or destroy the disease-germs in the mouth, gums, throat, fauces, 
such as are present in aphthae, scarlet fever, diphtheria, syphilis, 
tuberculae, mercury. 

Vinegar and Salt. 

Take of cider vinegar, half a pint; common salt, two table- 
spoonfuls ; mix. One or two tablespoonfuls in half a teacupful of 
warm water. Use as a mouth wash and gargle in all forms of sore 
throat. If patient is an adult the addition of a small amount of 
capsicum will render it still more efficacious. 

Muriatic Acid Gargle. 

Take half an ounce of muriatic acid ; one ounce of honey, 
and ten ounces of a good strong infusion of golden seal : mix. 



REMEDIAL AGENTS. 835 

Swab tonsils, uvula, and fauces with. Very useful in chronic 
tonsilitis, dropping of the palate, or sore throat generally. 

Sage Tea, Honey, and Borax. 

Make a pint of strong sage tea; keep it in an earthen tea-pot 
at side of fire ; add to it two or three ounces of honey and one 
ounce of borax. Use as a mouth wash and gargle in sore throat 
of all kinds, nursing (aphthse), syphilitic, mercurial. Gargle fre- 
quently. 

Sulphur Gargle. 

One teaspoonful of flowers of sulphur to half a tumblerful 
of tepid water. Use every two hours. Effectually destroys the 
germs of diphtheria. Or, blow the sulphur through a tube on 
the diphtheric membrane, and then gargle with the same. 

Chlorate of Potassa Gargle. 

Put an ounce of chlorate of potassa in half pint of water. Take 
of the solution three tablespoonfuls to the same quantity of hot 
water, and gargle every two or three hours, in all forms of sore 
throat, scarlatina, diphtheria. 

Golden Seal. 

Take a strong infusion of either golden seal, or gold thread, 
or bayberry, say a pint ; borax, one ounce : mix. Keep warm 
in an earthen teapot. Very serviceable in inflammation, ulcers, or 
abrasions about the mouth. Use every two or three hours. 

Borax Gargles. 

Take half an ounce of borax ; tincture of myrrh, one ounce : 
infusion of either gold thread or Peruvian bark, eight ounces ; 
mix. Excellent for removing the soreness of the gums after extrac- 
tion of teeth, or in ulceration about mouth and fauces. 

Take of borax half an ounce ; mix, or beat it up in one ounce 
of honey. Wash mouth out with plain w T ater. Then take a 
camel's hair brush and paint over all ulcers, abrasions, about 
four times a day. 

Take half an ounce of borax, one ounce of syrup of squills, 
and half a pint of water — or what is better, infusion of bayberry. 
Use as a gargle in chronic inflammation of the fauces. 

Borax and Wild Indigo. 

Make a strong pint infusion of wild indigo, and add to it 
half an ounce of borax. In order to keep infusion fresh add 
half a teaspoonful of chloroform to the entire quantity : mix. 
Of great utility as a wash, or gargle when great feter of the mouth, or 
breath exists. Used several times a day. 

Tannic Acid Gargles. 

Dissolve thirty grains of tannic acid in one ounce of alcohol, 



836 REMEDIAL AGENTS. 

and add to half a pint of camphor water. Use three times a 
day, and before using, paint the gums with the following : 

Tannic acid, one drachm; tincture of myrrh, half announce; 
alcohol, one ounce : mix. In scurvy of the gums, loosening of the 
teeth, or general sponginess, it is of great service. 

Alum and Myrrh, 

Dissolve one teaspoonful of alum in one ounce of tincture of 
myrrh, and then add two ounces of water. Use thrice daily. 
Invaluable in loose teeth, spongy gums. 

Chlorinated Soda Gargle. 

Mix half an ounce of liquor chlorinated soda with five ounces 
of water. First wash mouth and throat with tepid water, then 
use one tablespoonful of the above thrice daily in bad syphilitic, or 
mercurial sore throat. 

Permanganate Potassa Gargle. 

Dissolve half an ounce of permangate of potass in four ounces 
of water that has been boiled. Then take a half tumbler of 
tepid water, and add in twenty or thirty drops or more until it 
is a good violet color. Use frequently. Excellent in diphtheric 
ulceration and all forms of malignant sore throat. 

Tincture of Iodine Gargle. 

Drop thirty drops of tincture of iodine into half a tumbler of 
water, and use in the above manner and for the same diseases. 
The tincture of iodine will vaporize by holding the bottle in 
the warm hand, and it can be inhaled with the greatest advan- 
tage in bronchitis and consumption, by holding a small bottle 
of it under the nose. It is a good antiseptic. If it does not excite 
coughing use often. 

Sulphite of Soda Gargle. 

Make a strong solution — say, one drachm of the sulphite of 
soda to one ounce of water. With this paint all the ulcers on 
the tongue, inside of the cheeks and throat, four times a day. 
Then add one teaspoonful of the sulphite to one tumbler of 
tepid water, and gargle well. Of great utility in all forms of 
ulceration of mouth and throat. 

Tannic Acid and Chlorate of Potassa. 

Five grains each in half a teacupful, or more, of sage tea. 
The two ingredients must not be rubbed together in a dry state, 
as they will explode ; no danger in water. Repeat often. 

Soothing Gargle. 

Take mucilage of gum arabic, six ounces ; tincture of myrrh, 
half an ounce : mix. Add a teaspoonful to half a teacupful of 
infusion of bayberry, and use as a gargle. 



REMEDIAL AGENTS. 837 

Other Gargles, 

Such as a solution of common salt, makes a valuable gargle 
in inflamed sore throat. A solution of alum is also valuable 
in falling of the palate and tickling cough. Infusion of gold 
thread, when the throat feels raw. Infusion of capsicum is the 
best stimulating gargle to all weak throats. 

Sage Tea and Honey. 

Sage tea and honey make an excellent gargle ; or alum, or 
borax added to suit the condition. 

HYPODERMIC MEDICATION. 

The cellular tissue of the body is often a better medium for 
the administration of remedies than the stomach. In resorting 
to this method, select a portion of the body in which few veins 
exist, as over the shoulders or nape of neck, and in all cases 
use pure alkaloids in solution. It is performed as follows: 
Raise the skin between finger and thumb, and, with a rotatory 
movement, burrow the tube of the syringe into the cellular 
tissue at least half an inch. Then fill the syringe with the 
remedy prepared, screw it on, and press the piston so as to 
inject the required quantity. It will form a small, baggy 
swelling. Then withdraw the syringe with a rotatory move- 
ment, and for a moment or two press point of index finger over 
the orifice in the skin, so that it has time to contract. Never 
use in children, nor in acute disease, and very guardedly in women. 

Morphia. 

Either the sulphate or acetate of morphia are perfectly solu- 
ble in distilled water. Dose for injection, about one-quarter of 
a grain. Useful in neuralgia, in delirium tremens, for sleep, and to 
rouse the patient in apoplectic fits. 

Atropia. 

One-eightieth of a grain of the sulphate of atropia. Useful 
in intestinal obstruction, asthma, tetanus, neuralgia, chorea. 

Sulphate of Quinine. 

For hypodermic injection prepare the following : Take thirty 
grains of quinine ; fifteen grains of tartaric acid ; and add both 
to one ounce of distilled water to dissolve. Of that take thirty 
drops, and inject that much every two hours, for three times, 
before a chill. In the above form it gives rise to no pain nor 
abscess. For hypodermic use, it is best not to dissolve in any 
other acid ; for if we do, we may expect irritation and abscess. 
Those injections must be prepared from the pure alkaloid and 
used with caution, as none of the medicine is lost, altered, or 
diluted with stomach liquids. 



838 REMEDIAL AGENTS. 

Pilocarpine. 

Take one-third of a grain, and dissolve in distilled water, and 
inject. It excites immediate diaphoresis, affords instant relief in 
asthma. 

INHALATIONS. 

Although the bronchial mucous membrane is a poor absorb- 
ent, still it can be made use of to a limited extent in morbid 
conditions peculiar to itself, as catarrh, ulcerated sore throat, 
chronic laryngitis, loss of voice, bronchitis, tubercle. The 
remedies may be placed in a pitcher of hot water and inhaled 
by breathing the steam or vapor. Although it is much better 
to use a steam vaporizer, or atomizer, by which the remedy in 
a fine state of subdivision, can be breathed. The best class of 
remedies are antiseptics, as carbolic acid, tincture benzoin, 
borax, ammonia, sulphuric acid, iron, etc. They should be 
used twice or three times a day, patient sitting, if able, and 
taking deep, prolonged inspirations. The first inhalations 
should be short if from an atomizer, so that the patient becomes 
accustomed to their use. Afterwards they can be continued 
for longer periods. It is best to select occasions when the stom- 
ach is empty, so that the diaphragm can descend well. The 
following table will give the quantity of drug to an ounce of 
distilled water, with the diseases in which they are most useful : 

Carbolic Acid. — One to ten grains : Bronchitis, ulcerated sore 
throat, chronic laryngitis, consumption. 

Tincture Benzoin. — Half an ounce to the same quantity of 
water ; or thirty grains of benzoic acid to the ounce of water : 
Consumption, as above. 

Borax. — Five to twenty grains : Sore throat, bronchitis, laryn- 
gitis chronic. 

Chlorate Potass. — Five to twenty grains : Sore throat, diph- 
theria, scarlatina, bronchitis. 

Ozone et Chlorine. — From five to thirty drops : Invaluable in 
syphilitic sore throat. 

Permanganate Potassa. — Two to five grains : Syphilitic sore 
throat, chronic bronchitis, ozsena, diphtheria, consumption. 

Sulphuric Acid. — One to five drops : Same diseases. 

Chloride of Gold and Soda. — Two grains : Invaluable in all 
inflammations of the mouth and throat. 

Aqua Ammonia. — Half ounce to one of water ; or in a pitcher 
of hot water : Good in cases of loss of voice. 

Sulphate of Alum. — Five to twenty grains in hemorrhage and 
profuse secretion from the bronchi. 

Tannic Acid. — From five to twenty grains : Same as the above. 

Sulphate of Hydrastis. — Five grains : Invaluable for healing 
ulcers on the bronchial mucous membrane. 



REMEDIAL AGENTS. 839 

Sulphate of Sanguinaria. — Five grains in chronic catarrhal af- 
fections, oedema of the glottis, laryngeal ulceration. 

Chloride of Ammonia. — Five to ten grains : Excellent to pro- 
mote expectoration in capillary bronchitis. 

Many other remedies might be enumerated, but we would 
not recommend morphia, atropia, aconitine, hyoscyamine, or 
other alkaloids to be used, as we are unable to say how much 
ulceration exists in the bronchi in those affections ; consequently 
no accurate rules can be laid down for a dose in an atomizer. 
The value of warm, moist air, alone, in bronchial affections, can 
never be overestimated, as its inhalation very greatly diminishes 
the amount of oxygen present, and renders the air breathed 
less irritating to the air-cells of the lungs. 

Iodoform. 

Dissolve two drachms of iodoform with sulphuric ether, so 
that there be no sediment. To that solution add two drachms 
of chloroform, and two drachms of alcohol, and ten grains of 
carbolic acid : mix, shake well. Put half an ounce of the mix- 
ture into a half-ounce bottle, and smell by the nose very fre- 
quently. Of very great efficacy in catarrh, or cold in the head. 
Good for headache. 

INUNCTION, 

Inunction consists in the rubbing into the body some oleagi- 
nous body, medicated or otherwise. 

In performing this, the body should be first thoroughly 
bathed or sponged with warm castile soap and water, well 
dried, rubbed with the dry hand, and then the substance 
rubbed in. 

Inunction of warm olive oil — say, from four to six ounces 
every evening — promotes nutrition, and is valuable in all wast- 
ing diseases, as lung consumption, tabes mesenterica, etc. 

Inunction of warm olive oil, with a few drops of oil of euca- 
lyptus, not only soothes the skin, smothers and destroys the 
germs, which are chiefly to be found in the desquamation, and 
thus prevents the spread of the disease, besides it is valuable to 
diminish reflex irritation. 

Inunction of warm olive oil, with a greater excess of eucalyp- 
tus, is of great efficacy in typhoid fever, not only in destroying 
the germs, the factor of the fever, but it lowers heat, diminishes 
pulse and respirations. 

Inunction of tartar emetic ointment into the abdomen in 
peritonitis, is retrograding to germ development, and is thus 
curative in this fatal disease. 

Inunction of various medicated ointments, to promote the 
absorption of swellings, the discussing of tumors, are of utility. 



840 REMEDIAL AGENTS. 

Inunction of olive oil, thymol, and chloroform is of great 
benefit in deep-seated parasitic disease of the skin. 

Inunction of antiseptic oleaginous bodies, as oil, camphor, 
menthol, turpentine, are of value in germ diseases. 

LINIMENTS AND OINTMENTS. 

Tincture of Cantharides and Borax. 

Take one pint of bay rum ; one ounce of muriate of ammonia ; 
one ounce of the tincture of bloodroot ; two of the tincture of 
lobelia ; two of the tincture of cantharides ; and one of borax : 
mix. Or, 

Take aromatic spirits of ammonia, one ounce ; glycerine, two 
ounces; tincture of canthrarides, half an ounce; rose-water, 
half a pint : mix. Where the hair is falling off, wash the scalp night 
and morning, dry well, then use either of the above. 

Belladonna, Muriate of Ammonia, and Iodide of Potass, 

Take one ounce of belladonna ointment; two drachms of 
iodide of potass ; and two drachms of muriate of ammonia : 
mix. Excellent to absorb tumors or swellings; but if applied to the 
female breast during the period of nursing, it will at once arrest the 
secretion of milk, 

Iodide of Lead. 

Rub up one drachm of iodide of lead in one ounce of bella- 
donna ointment. This is excellent in painful swellings. It can be 
gently rubbed in, or spread on linen, and applied. 

Iodide of Cadmium. 

Take a drachm of iodide of cadmium, and add it to one 
ounce of belladonna ointment. This is much more efficient in 
decreasing swellings, indurations, enlargements, than iodide ofpotassa. 
It is best both to rub it in and apply on a cloth three times a day. 

Iodide of Sulphur, 

One or two drachms to the ounce of vaseline ointment: mix. 
Makes an efficient remedy for the destruction of the cryptogam of 
barber's itch. 

Other Ointments. 

Stramonium ointment, useful in neuralgia and indurations. 



Aconite 


it 


a 


neuralgia. 


Veratria 


a 


u 


erysipelas. 


Citrine 


u 


a 


ophthalmia tarsi. 


Iodine 


a 


a 


discutient. 


Sulphur 


u 


a 


parasitic disease. 


Carbolic Acid 


u 


a 


u « 


Poke Root 


a 


u 


discutient. 


Lobelia 


a 


u 


a 



REMEDIAL AGENTS. 841 

Sulphuric Acid Ointment. 

In making the sulphuric acid ointment, it should be made 
different strengths, to suit the disease and skin of the patient. 
Take one ounce of simple cerate and mix thoroughly in it 
thirty drops of sulphuric acid ; that is medium strength ; It 
may be made as low as ten drops or up to sixty — not higher. One 
of the best of all ointments in parasite disease of the skin. Rub 
in gently, and spread on linen and apply. 

Iodoform Ointment. 

This ointment is made all strengths, from ten grains up to one 
hundred and twenty grains to the ounce, of simple cerate. Best 
results are obtained from thirty to sixty grains to the ounce. 
Invaluable ointment where we want to promote absorption. Rub in 
and spread on linen, and apply thrice daily. 

Borax Ointment. 

Rub up as much borax as possible in fresh lard, or simple 
cerate, or vaseline; not enough to destroy its cohesive property. 
Excellent to heal sores, ulcers, and as a general dressing. 

Chrysophanic Acid Ointment. 

Take one drachm of chrysophanic acid and one ounce of 
vaseline: mix. First bathe the skin well, and then rub into 
the affected part twice a day. Very useful in obstinate lepra, or 
psoriasis. 

Thymol, or Menthol Ointment. 

Take of either thymol or menthol, two drachms ; chloroform, 
half an ounce; olive oil, one ounce; vaseline, half an ounce ; mix 
well. Cleanse the part either by bathing or poultices, or both ; 
dry, and then apply this ointment twice a day. Rub in well, 
if not tender. The chloroform carries the antiseptic thymol 
down to the deeper parts, and destroys all cryptogams. It is 
very valuable in parasite affections of the skin. 

Chloral Hydrate and Camphor. 

Take one ounce of vaseline ; two drachms of camphor ; and 
one drachm of chloral hydrate : mix. Rub into the cervical 
portion of the spine in cases of epilepsy ; also very good in 
pruritus about the anus, fundament and vulva. 

Some introduce bromide of potass into the same ointment, 
with the notion that the drug enters the circulation and quiets 
the motor and sensory nerves. 

Pyrogallic Acid. 

Take vaseline, one ounce ; pyrogallic acid, half a teaspoon ful ; 
mix. Very useful in tetter. In this form it is not readily ab- 
sorbed, and can do no harm, like a hair dye. 



842 REMEDIAL AGENTS. 

Soothing Ointment. 

Take of vaseline ointment five ounces ; gum benzoin, finely 
powdered, one ounce ; liquefy the vaseline with heat, and dis- 
solve the benzoin ; and then add one ounce of the white oxide 
of zinc. If too thick for the use intended, bring it to the proper 
consistency desired by adding to it glycerine. Excellent for the 
skin to render it soft and velvety. Nothing deleterious in it like bis- 
muth. Good for freckles, chafed, or irritated skin. 

Vaseline and Eucalyptus. 

Take of vaseline ointment one ounce ; oil of eucalyptus one 
drachm ; iodoform, twenty grains : mix. Powerfully antiseptic. 
Excellent to apply when lupus has been removed, or warts scraped off. 

Vaseline and Iodoform. 

Melt one drachm of Peruvian balsam in one ounce of vase- 
line ointment ; then add twenty or more grains of iodoform. 
Made in this way all the irritating action of the iodoform is 
covered up. Very useful for tender enlarged glands about neck or 
groin. 

Pile Ointment. 

Take one ounce of simple cerate and incorporate in it one 
drachm of Monsul's perchloride of iron. Bathe the fundament 
well with cold water ; dry well. Spread a small piece of this 
salve on a rag, and press well up against the parts. It quickly 
causes them to disappear. Or, 

Add the oil of horse-chestnut to simple cerate, or gall ointment. 

To Disperse Swellings. 

Take one ounce of stramonium ointment, one of poke root 
ointment; muriate of ammonia, half an ounce; iodoform, one 
drachm: mix. Spread on linen and apply. If it reddens, re- 
move, apply a poultice, and when the redness disappears, re- 
apply the ointment. 

Simple Cerate. 

Take lard, four ounces, free from salt, and fresh ; wax, one 
ounce. Melt the wax and add the lard, and stir while cooling. 

Vaseline. 

A distillation, or gelatine or jelly, from petroleum, or coal 
oil, is superseding all forms of ointments. It is very valuable, 
but not so stable or fixed as simple cerate ; that is, it evaporates 
very readily. It is well adapted for all antiseptic bodies ; much 
better than any other cerate or ointment. Cosmoline, chrisma, 
are other names for vaseline. 

Iodoform Ointment. 

Dissolve as much iodoform in ether as it will take up ; then 
add to vaseline. A good ointment in catarrh. 



REMEDIAL AGENTS. 843 

Magic Liniment. 

Take one quart of alcohol, ninety-five per cent., and add to 
it the following articles: Oils of sassafras, hemlock, origanum, 
spirits of turpentine, chloroform, balsam of fir, oil of winter- 
green, and gum camphor, one ounce each. This makes a splendid 
liniment for bruises, neuralgia, or any painful swelling. 

Liniment for Chilblains and Bruises. 

Take two ounces of the oil of hemlock ; two ounces of oil of 
origanum; two ounces of spirits of turpentine; two ounces of 
hartshorn ; two ounces of chloroform, and two ounces of alcohol : 
mix. Shake well before using ; keep well corked, and apply freely 
and frequently. 

Spirits of Camphor. 

Is made by dissolving two ounces of camphor in one pint of 
alcohol at ninety-five per cent. To secure the full benefit of 
this as a local application, it should be applied by wetting a 
cloth, and applying; then covering with oiled silk. 

Camphorated Oil or Lard. 

Is prepared by heating oil or lard in the same proportions 
as the above, and dissolving the camphor in it. Valuable in 
inflamed breasts, or any painful part. 

Pain Killer. 

Take spirits of hartshorn, one ounce ; olive oil, one and a 
half ounces; cayenne pepper, two drachms; laudanum, two 
drachms ; one tablespoonful of salt ; and two tablespoonfuls of 
brandy: mix. Or, 

. Take two ounces of oil of spike ; two ounces oil of origanum ; 
two ounces oil of hemlock ; two ounces oil of wormwood ; four 
ounces of sweet oil; two ounces of spirits of ammonia; two 
ounces of gum camphor ; two ounces of spirits of turpentine ; 
add one quart ninety-five per cent, alcohol : mix well together, 
and keep well corked. One of the best liniments for all pains. 

Black Salve. 

Take olive oil, one pint ; common resin, half an ounce ; bees- 
wax, half an ounce; Venice turpentine, half an ounce. Melt 
all together, by raising the oil to the boiling point; then gradu- 
ally add two or three ounces of red lead while on the fire. Keep 
stirring, and do not burn it ; boil slowly till it becomes a dark- 
color; then remove from the fire; still keep stirring, and as it 
gradually cools, add about half an ounce of pulverized cam- 
phor to the mass. This makes a splendid healing salve. Useful in 
burns, scalds, ulcers. Spread on linen, and renew once or twice 
dailv. 



844 REMEDIAL AGENTS. 

Basilicon Ointment. 

Take of yellow wax, eight ounces; Burgundy pitch, three 
ounces ; Venice turpentine, four ounces ; linseed oil, ten ounces. 
First melt the pitch, to which add the wax and turpentine ; 
and when they are all melted, slowly pour in the oil, stirring 
till it is cold. A very valuable dressing for abscesses. 

Sulphur Ointment. 

Mix together one ounce of sublimed sulphur, and two ounces 
of lard. A cheap ointment for itch. 

Vegetable Ointments, 

Such as cucumber, stramonium leaves, poke root, carrots, and 
other vegetable agents, are made by simmering the remedy in 
lard until its properties are extracted. 

Salve for Sore Breasts, or Testicles. 1 

Take one pound of lobelia plant ; one pound of spikenard ; 
half a pound of comphrey ; and boil them in three quarts of 
strong ley. Boil till they are almost dry, then squeeze out the 
juice, and add to it pitch and beeswax, and simmer to a mode- 
rate consistency. Spread on cloth, and apply, changing once 
in the twenty-four hours. 

Burns. 

The carbolic acid and olive oil is the best ; but when that 
cannot be procured, do not wait, but apply one or other of the 
following : Ordinary white lead, painted on thick with a brush ; 
or linseed oil, chalk, and vinegar ; lime-water and olive oil ; 
or a slippery elm poultice made with milk ; flour and lard, or 
vinegar alone. Glycerine is good for burns with gunpowder. 

Indian Turnip. 

Put on a sufficient quantity of fresh lard in a saucepan, and 
add the Indian turnip fresh and sliced up ; and when it becomes 
crispy, remove, and add more until a good ointment is thus 
formed ; after which put in jars. Very useful in scald and ring- 
worm. 

Lime-Water and Tincture of Iodine, 

Take one pint of lime-water, and one ounce of tincture of 
iodine : mix. This makes a valuable application to old sores, chan- 
cres, scald-head, erysipelas. 

For Bunions. 

To take the pain out of a bunion, take half an ounce of castor 
oil, and the same quantity of nitrate of potass : mix thoroughly 
together; then spread one-eighth of an inch thick over the 
bunion. Relief is often instantaneous. 



REMEDIAL AGENTS. 845 

For Burns. 

Take two pounds of common sugar : two pounds of slaked 
lime ; beat them well together ; and then add a sufficient quan- 
tity of water (keeping stirring) to reduce the mixture to a thin 
liquid. Then shake it well together, and let it stand forty- 
eight hours; filter through muslin, and then evaporate to the 
consistency of molasses. Then mix this thick syrup with an 
equal quantity of a liquid containing one part glycerine and 
three of olive oil. It is very valuable for burns, and contains 
more lime than the other mixtures. 

LOTIONS, WASHES, INJECTIONS. 

Soap Wash. 

Shave up castile soap into a quart of boiling water. When 
cool, it is a useful wash or injection. 

Lime-Water. 

Take one-half lime-water, one-half water : mix. Appty as 
a lotion in erysipelas and venereal sores; as a wash or injection in 
leucorrhoza. Tincture of iodine can be added — say, a teaspoonful 
to a pint, for injection. Lime-water is easily prepared, by placing 
a lump of lime in a bucket, and filling up with boiling water; let 
it stand over-night, skim off the glistening surface in the morn- 
ing, which throw away, and then pour off the clear water into a 
bottle, and save for use. This is a little stronger than what is 
sold in the drug stores, and better. 

Borax. 

For injections in the vagina in gonorrhoea, use from one 
to two tablespoonfuls of borax to each pint, or more. For lotions 
in pruritus, or itching, two tablespoonfuls to eight ounces of 
water, or much stronger, even sprinkling the pulverized borax 
over the inflamed part. It is the most useful of all lotions, 
washes, injections. 

Iodine. 

Tincture of iodine, one ounce ; lime-water, half a pint : mix. 
Or, 

Tincture of iodine, one ounce ; carbolic acid, two drachms ; 
water, one pint : mix. Useful washes or lotions in all parasitic 
skin diseases, itching, scrofulous sores, chancres, etc. 

Vinegar, 

Cider vinegar, one pint; warm in a porcelain kettle, and 
when hot, add half a pound of saltpetre. Dissolve, saturate 
flannel, and apply over inflamed joints in gout; or over the female 
breast, if desirous to arrest the secretion of milk, or soften or discuss 
a swelling. Apply as hot as can be borne, and cover with oiled 
silk, and remove as it dries. 



846 REMEDIAL AGENTS. 

Sulphurous Acid. 

Take of sulphurous acid, two ounces; water, six ounces: 
mix. Brush over the skin in ringworm, or wet linen and 
apply. Or, 

Take one ounce of sulphurous acid ; one ounce of glycerine : 
mix. Paint over the skin where there is ringworm, or any vege- 
table disease of the skin. 

Cold and Hot Lotions. 

Take a pint of water : half a pound of muriate of ammonia ; 
half a pound of saltpetre ; four ounces of common salt ; one 
ounce of tincture of iodine : mix. Saturate a piece of flannel 
and apply, and cover with oil-cloth, or oil-silk, and keep wet. 
The first sensation for ten or fifteen minutes is extreme cold, 
which is followed by a most pleasurable sensation of heat, and 
between the two extremes of heat and cold, lymph is rapidly 
absorbed. It is a most excellent application in enlarged testicle. 

Gold Lotions. 

Take eight ounces of camphor-water; one ounce of liquor 
ammonia acetatis ; and two ounces of alcohol. Or, 

Take one ounce of muriate of ammonia ; one ounce of alco- 
hol ; half an ounce of saltpetre ; and half a pint of vinegar : 
mix. Either is excellent in cases of inflammation of the brain. 

Muriate of Ammonia. 

One pound of muriate of ammonia ; place in a quart jar and 
cover with boiling water. Bottle all up, that which is undis- 
solved with the dissolved. Handy to have in the house, as it 
instantly kills the poison of bugs, wasps, bees, poisoning by ivy, sumach, 
mosquitoes, poisoned wounds or cuts, erypsipelas, snakes, reptiles. Keep 
a cloth ivet ivith it constantly applied to the bitten or wounded part. 

Chlorate, or Permanganate of Potassa, 

Chlorate, or permanganate of potass, or both combined, say 
one grain of each to the ounce of water. Use as an injection in 
gonorrhoea, or leucorrhosa ; or, as a wash for poisoned wounds. In- 
jections into the urethra should be copious, never less than 
an ounce ; whereas, into the vagina never less than a pint. 

Sulphurous Acid Injections. 

First, wash out the urethra, or vagina, well, with copious in- 
jections of soap water and borax, to cleanse ; then throw up 
cold water, rendered sour with sulphurous acid. Great efficacy 
in gonorhcea and leucorrhoea. 

Solution of Atropia, 

Take two grains of sulphate of atropia ; distilled water, one 
ounce : mix. Drop a few drops into the eye to dilate the pupil, 
twice a day, in all inflammations of the eye. 



REMEDIAL AGENTS. 847 

Alum Coagulum. 

Take the white of several eggs, shake them up with frag- 
ments of alum until a good coagulum is formed. Take this coagu- 
lum and apply to or over the eyes, in inflammation, albugo and other 
states in which an astringent is needed. 

Iodide of Fotassa Lotion, 

Take four ounces of distilled water ; iodide of potassa twenty 
to thirty grains : mix. Useful as a lotion in intra-uterine catarrh, 
membranous dysmenorrhea, chronic inflammation of the conjunctiva, 
and where lymph has been effused. 

Zinc Injection. 

Take twenty grains of acetate of zinc; five grains of the ace- 
tate of morphia, and four ounces of rose-water : mix. Or, take 
oxide of zinc, thirty grains ; rose-water, four ounces : mix. Either 
makes an excellent eye wash. 

Elder Flower Water. 

Take ten ounces of elder flower water; iodine, two drachms : 
mix. Wet cloths with this lotion and apply in all forms of 
pruritus. It gives instant relief. 

Infusion of Lobelia. 

Take a pint infusion (made by pouring boiling water on a 
handful of lobelia leaves and stems), and when strained, add 
either borax or iodine, same as the above. Good for pruritus. 

Camphor Water. 

Pulverize two drachms of camphor in a mortar; then add a 
large teaspoonful of alcohol ; then rub into it half an ounce 
of carbonate of magnesia. Mix well and add gradually two 
pints of boiled water. Then filter through blotting paper. 

Other Waters, 

Such as fennel, bitter almond, cinnamon, peppermint, and 
spearmint waters, are all prepared by taking half an ounce of 
the oil and mixing with one drachm of carbonate of magnesia, 
and gradually adding two pints of distilled or boiled water. 

Lime Water. 

Take of lime, two ounces ; boiled water, two quarts. First 
slack the lime with a little of the water, then pour on the bal- 
ance and let it rest over night. Filter off the clear liquid, and 
put away in a bottle for use. Dose, from half to a teaspoonful 
three times a day in milk. It is an antacid, antiseptic, kills 
parasites and worms, frees the bowels from slimy and morbid matter. 
Besides, it promotes digestion and is valuable in irritable stom- 
ach, looseness of the bowels. Mixed with an infusion of Peru- 
vian bark it is wonderfully strengthening. 



848 REMEDIAL AGENTS. 

Balm of Gilead Lotion. 

Fill a bottle with balm of Gilead buds ; then cover with 
whiskey. Cork up. Very useful to have in the house for cuts, 
bruises, wounds. 

The Black and Yellow Wash. 

The black wash is made as follows : Take of calomel, one 
drachm; lime-water, one pint: shake well. The yellow wash 
as follows : Corrosive sublimate one-half drachm ; lime-water, 
one pint : mix and shake well. Both washes should be well 
shaken up before using. They are extensively used by the old 
doctors in syphilitic sores. - 

Tar Water. 

Tar water is prepared by introducing two pints of tar into a 
gallon of boiled water. The mixing is effected by stirring the 
tar into the water by a wooden rod, and then allowing all 
refuse to settle to the bottom; then strain the liquid off. It 
should have the color of white wine. It is useful internally as 
well as locally ; it acts as a stimulant and antiseptic. It may 
be drunk freely. Useful in diabetes, bronchitis, skin and kidney 
diseases, and old ulcers. 

Bay Rum. 

Take one ounce of the oil of bay leaves ; two ounces of pul- 
verized muriate of ammonia ; one gallon of alcohol and one 
gallon of water. Put the ammonia in a mortar, on which pour 
the oil of bay ; rub up well ; then add about half a pint of the 
alcohol ; rub up well, and add to the entire amount of alcohol ; 
shake well; let it stand overnight; shake again; then add the 
one gallon of water. If desirous of making it look like pure 
bay rum add a few drops of caramel to give it the requisite 
shade. Excellent for bathing the sick. Oil of eucalyptus can be 
added if desired. 

For Freckles. 

Take five grains of corrosive sublimate; two drachms of 
dilute muriatic acid ; four ounces of water ; two ounces of alco- 
hol ; two of rose-water ; and one drachm of glycerine : mix. 
First wash the face, before going to bed, with borax soap; then 
apply the lotion, and wash off with soap in the morning. Very 
efficacious. 

For Burns. 

Take equal parts, by weight, of coarse, brown sugar and 
slaked lime ; pound them well in a mortar ; to this add a small 
quantity of water, from time to time, until the mixture becomes 
very liquid. After allowing it to stand forty-eight hours filter 
through a piece of linen, and then evaporate to the consistency 
of thin syrup. Then mix this with a liquid of equal parts of 



REMEDIAL AGENTS. 849 

olive oil and glycerine. This makes a good application for 
burns. 

Ox-Gall Lotion. 

Take half a pint of alcohol ; add to it one ounce of camphor ; 
let this dissolve; then add half a pint of ox-gall, and two. tea- 
spoonfuls of laudanum. Shake well and bottle for use. It is 
very efficacious in fresh wounds, cuts, bruises, swellings, sore or in- 
flamed parts. 

Benzine for Itch. 

In cases of itch, rub the entire body over with benzine for 
half an hour. Then take a warm alkaline bath, and change all 
the wearing clothes as well as the bed-clothes. 

Sweaty Feet, with Bad Odor. 

If the borax wash does not cure, try a solution of perman- 
ganate to destroy the fetor : five grains to each ounce of water. 

Lotion for Diphtheric Ophthalmia. 

Dissolve six grains of quinine with a few drops of sulphuric 
acid, and then add to one ounce of water. To be used freely as a 
wash, and by keeping a compress constantly wet with it to the 
eye Excellent lotion. Or, 

Take two drachms of boracic acid ; glycerine, half an ounce ; 
water, one ounce : mix. This can be either applied to the eye or 
throat. It destroys the exudation. 

A Jet Black Hair Dye. 

Take six ounces of distilled water; one ounce of aqua ammo- 
nia ; and a quarter of an ounce of nitrate of silver : mix. Before 
using wash the hair and scalp well ; dry thoroughly, and ap- 
ply by means of a tooth brush. Apply once a week. The am- 
monia is supposed to prevent the absorption of the nitrate of 
silver. 

Another Hair Dye. 

Take one drachm of lac sulphur ; one drachm of sugar of 
lead, pulverized ; then add them to one ounce of glycerine ; one 
ounce of tincture of cantharides ; two ounces of bay rum, and 
one pint of rain water : mix. Before using wash head ; dry 
thoroughly and use as a hair dressing once a week. 

MASSAGE. 

This is a general term that is used for quite a variety of pro- 
cedures, such as shampooing, kneading, beating, rubbing, and 
passive exercise of the muscles, nerves, and vessels of the entire 
body, or a part of it, as the extremities, trunk / back, or other 
parts. Massage is best performed by at first taking half an 
hour, morning and night, for its performance, and gradually 

66 



850 REMEDIAL AGENTS. 

increasing the length of time to one and a half to two hours, 
and invariably to be performed by an attendant remarkable 
for vigor of mind and body, and not over thirty-five years of 
age. The entire body may be sponged off with castile soap and 
water, and well dried with a Turkish towel before beginning. 
Then the process of shampooing, or handling, is to be com- 
menced. It is best to begin at the extremities, and follow with 
front and back of the body. The parts from the skin to the 
bone are to be well manipulated, first by friction, then by 
thumbing or kneading ; then gentle beating, or grasping. This 
at once improves the cutaneous circulation, creates muscular 
growth, imparts vital energy, and its reflex effect on a weak- 
ened cord or bulb are beyond all possible description grand 
and efficacious ; the muscles, vessels, and nerves are exercised, 
and their lost tonicity restored without the expenditure of 
nerve-force, but by its acquisition ; it is, as it were, stamped in. 
To do it effectually requires an intelligent and experienced 
person, thoroughly drilled into it, and having some knowledge 
of the large muscles, at least. It is surprising in its effects ; a 
most miraculous improvement in all cases of nerve-tire or 
exhaustion begins at once, which progresses on to complete 
recovery. The manipulation at first is trying, but in a few 
days the patient enjoys it ; and by and by it acquires a true 
fascination, or charm, when pains, aches, chronic nerve-diseases 
of twenty or thirty years' standing yield to its potent influence. 
It is to be done with kindness and efficiency, and each part 
as manipulated carefully covered ; and then another, and gone 
over several times until the allotted time has expired. It is 
usually followed by most refreshing sleep. It is troublesome, 
requires care, great patience, some skill, a willing effort, and 
affords the only means of overcoming a weakened cord and 
bulb, which is the predominating symptom in nerve-exhaustion 
of both sexes, vulgarly termed hysteria. Its very great efficacy 
is much enhanced by seclusion, rest, a brain diet, and electricity. 
It is indicated in all chronic nervous diseases, where nerve-energy is 
lost or impaired; refreshes the nerves tired by worry, excitement, study, 
or excess. It gives renewed vigor in all forms of nervous exhaustion 
or debility, and is a positive cure for hysteria. 

Nervousness and Bedridden Hysteria. 

The cure of nervousness, so called, which is simply anaemia 
of the nerve-centres, is best accomplished by restoring the 
healthy action of all the organs in the body, and proper diet, 
and exercise in the open air. Sumbul is far superior to vale- 
rian in all nervous disorders, lowness of spirits, restlessness, 
irritability. But it should always be borne in mind that there 
is no remedy equal to seclusion, rest, a brain diet, and massage 



REMEDIAL AGENTS. 851 

by a vital attendant ; no remedy of any kind comparable to 
the proper and constant use of intelligently applied massage. 

OZONIZED REMEDIES. 

The largest number of diseases of civilized man are of his own 
production, and are the result of the degradation of the living 
matter of our own bodies into disease-germs, or micro-organ- 
isms, which contaminate the body in which they are degraded 
and, being so light, are diffused through the air by exhalations 
from breath and other excretory channels. The vitalized oxy- 
gen of the atmosphere, or ozone, destroys the larger proportion 
of them, but others are taken in by individuals of weak vital 
force, and disease spread. Ozone in nature is the great atmos- 
pheric scavenger, as well as the scourer of diseased blood. It is 
a parasiticide wherever found. 

On August 27th, 1878, 1 secured Letters Patent, No. 207,496, 
for manufacturing Chemically Pure Ozone, which can be made 
artificially and introduced into a large variety of remedies, 
thereby changing, but always increasing their antiseptic prop- 
erties, if they possess any, giving us a class of remedies of won- 
derful power in all diseases in which a living poison is pres- 
ent in the blood — giving us remedies that can annihilate can- 
cer, tubercle, syphilis, catarrh, erysipelas, small-pox, scarlatina, 
diphtheria, and other germs. 

All Fixed and Essential Oils, 

As castor, cod liver, olive, and oils of turpentine, erigeron, rose- 
mary, cajeput, eucalyptus, cloves, etc., as also various fluid ex- 
tracts, can be very highly ozonized. 

Glycerite of Ozone. 

The hypophosphate of lime and soda are first added to glyce- 
rine, and then submitted to the action of chemically pure 
ozone for forty-eight hours, when it is ready for use. Dose, 
from fifteen to thirty drops three times a day, for the first few 
days ; then from thirty to sixty drops after a week, so that the 
largest dose is one teaspoonful, always added to a little water. 
Of ivonderful efficacy in consumption, as it destroys the tubercular 
germ in the blood. 

It is the only remedy, so far discovered, that will positively 
cure consumption in its first and second and stage. Besides 
being curative in tuberculosis, it is a remedy of the greatest 
importance in all wasting diseases; it creates a general increase 
of nervous energy, with a feeling of ease and comfort. It also 
increases the appetite ; digestion is improved, the bowels become 
regular and healthy, night-sweats and other indications of de- 
bility disappear. The blood is made pure, free from diseased 
germs, and its quantity and color is increased ; there is more 



852 REMEDIAL AGENTS. 

life, vitality, as is manifest by easy breathing, cool skin, the 
expansion ; the skin improves, the cough disappears, the face 
becomes natural, the lips red, and there is great vivacity ; in- 
deed, the whole body is permeated by new life. Besides its 
wonderful action in consumption, it can be used with great 
benefit in all blood diseases, in fevers and exhaustion, whenever 
vital force is the least impaired. Its effects are most apparent 
in bloud and nervous diseases. In all ages and both sexes it 
acts equally well in giving tone and vigor to the system. 

Glycerite of Kephaline Ozonized. 

The ordinary glycerite of kephaline is submitted to the action 
of ozone gas for about a week, until it takes up about twelve 
atmospheres of ozone. The dose is from ten to twenty drops, 
added to a little water, thrice daily. This is not only a most 
powerful brain food, but also a nutrient tonic and antiseptic, and 
of the greatest possible value in consumption, dyspepsia, loss of 
memory, nervous debility, decay of brain power, nervous prostra- 
tion, neuralgia, loss of vital power, general vital deterioration, sleep- 
lessness. It is also of great efficacy in leucorrhcea, catarrh of 
the uterus, and female weakness. Besides its action as a brain 
or nerve food, it restores lost energy, refreshes the nerves, tired 
by worry, excitement, or excessive sensitiveness, strengthens, 
gives renewed vigor in all nervous diseases. A positive cure 
for seminal weakness and loss of power in the generative organs. 
A grand restorer of lost nerve force. 

Ozone Water. 

The saturation of distilled water with chemically pure ozone, 
gives us a remedy of rare power. Dose, from half to one teaspoon- 
ful thrice daily in water. The great efficacy of ozone water is 
in the destruction of micro-organisms, or disease-germs in the 
blood ; hence, it is of inestimable value in tubercular, cancer, 
syphilis; in measles, scarlatina, and small-pox; the latter it 
completely annihilates ; in all fevers caused by a living con- 
tagion, as typhoid, bilious, remittent, yellow fever ; in erysipelas, 
boils ; and it is so very powerful that it destroys the sarcinse ven- 
triculi in the stomach. On the nervous system it operates like 
a charm ; it frees the brain from all induration, improves the 
memory, promotes sleep, arrests white softening, obviates ner- 
vous debility, puts a stop to fits, epileptic or otherwise, relieves 
chorea; obliterates erratic pains, or neuralgia. Ozone water 
has a most extensive range of action, and wide sphere of utility. 
It is also excellent in debility, and so vitalizes the origin of life 
in the user, that it causes the very hair to grow, and even the 
teeth in children, increases the appetite and improves digestion. 
In all contagious diseases and loss of vigor in the intellectual 
powers, its action cannot be surpassed by any drug or combina- 



REMEDIAL AGENTS. 853 

tion of drugs. It puts a complete stop to softening of the brain, 
which is so common. 

Ozone et Chlorine. 

This is a combination of the two gases condensed in distilled 
water. It is not to be used internally, but locally, for painting- 
ulcers, sore throat, ulcers about the neck of the uterus, and other 
sores. It may be used as an injection with wonderful success 
in catarrh of nose and vagina. From two ounces to two and a 
half ounces are added to sixteen ounces of distilled water for 
a nasal douche or vaginal injection. It destroys all disease- 
germs with which it comes in contact. One thorough douche 
with it in catarrh will cure cases of twenty to thirty years' 
standing. It is a most wonderful remedy. When desirous of 
having a beautiful exhibition of the disease-germs from the 
nose, or vagina, or urethra, color the sixteen-ounce injection 
with from eight to ten grains of permanganate of potassa. 
After one douche, in a well-marked case of nasal catarrh, it is 
estimated that over thirty millions of the amoeba will pass off 
in the discharge from the one application. It would be well 
never to exceed the above strength. The two gases are com- 
bined in definite proportions, and make a most reliable appli- 
cation. It affords us the only speedy, reliable method of getting 
rid of this prevalent, loathsome, and hitherto intractable disease. 
If ever a second treatment is necessary, it should be at least 
three or four weeks apart, and not so strong as the first. After 
one douche, in a bad case of nasal catarrh, the vertigo, the 
pasty or doughy appearance of the skin, the dispepsia, languor, 
lassitude, debility, leave; the skin becomes natural in color, lips 
red, and the indescribable "tire" sensation disappears. It pro- 
duces a perfect revolution in the whole body, and a speedy 
restoration to good health. 

Chloride of Chromium, Ozonized. 

First make, say, a pound, saturated solution of the chloride 
of chromium. Then introduce ozone gas into it for a week, until 
it takes up twenty atmospheres of chemically pure ozone. Then 
take the liquid so formed, and add to some inert powder, such 
as bloodroot, or licorice, or flour, so as to form a semi-liquid mass 
or paste. Then the cancer should be mapped out in the most 
correct manner ; all the adjacent parts should be covered with 
adhesive plaster, leaving the cancer, or parts covering it, bare. 
Then take the plaster, half an inch or an inch thick, and apply 
over the cancer, covering with a little cotton. As soon as it 
dries, or cakes, it is to be removed, another applied, and done 
a few times, if the cancer is deep ; if small, flat, and superficial, 
one application will be sufficient. The object to be attained is 
to get the remedy to penetrate to the deepest roots. The mix- 



854 REMEDIAL AGENTS. 

ture will not in any way affect the sound skin or surrounding 
parts ; but it stains, and it is well to have a clean surface. It 
gives no pain, nothing but a slight warmth, but seems to search 
and penetrate for the disease cancer-germ, with which it unites, 
and at once destroys. It is, so far, the only true chemical anti- 
dote yet discovered for cancer. After its application the cancer 
becomes hard, a dead, inert mass, which, if small, may be ab- 
sorbed, but is more likely to sever its connection with the living 
tissue or surrounding parts, and be thrown off. If it should 
happen that it has not been put on frequent enough, and the 
roots are not all destroyed, they can be touched in the process 
of exfoliation. It is the best plan to effectually destroy it at 
first. After it has been thoroughly annihilated, which takes 
from a few minutes to a few hours, poultices should be steadily 
used until it drops out, which will be in from a few days to a 
week or ten days at the longest. If it drops out clean, and 
there is no odor of dead cancer-germs, it should be dressed with 
ozone ointment, and kept in apposition by strips of adhesive 
plaster or bandages. If, however, more germs form, it can be 
brushed over with the ozonized chloride of chromium, then 
poulticed as before, and internal treatment pushed with vigor. 
This is a perfectly painless and most successful treatment, and 
supersedes all other methods, as being painless, and not a drop 
of blood lost in the process. 

Ozonized Clay. 

Potter's clay, rubbed down to an impalpable powder in a 
mortar, then saturated with spring-water to the consistency of 
molasses, and then heavily charged with the ozone gas, bottled 
up, and is ready for use. To be spread between layers of fine 
book muslin, from a quarter to half an inch, or even more, in 
thickness, and bound firmly, either with adhesive strips or 
bandages, or both, over the affected part. If it causes no red- 
ness of the skin, it can be applied fresh daily ; but if there be 
redness, it may be taken off and broke up, remoistened, and 
applied again for four, five, or six days in succession ; or if it 
then causes redness, it can be left off entirely for a few days. 
In its application, never cause any irritation or redness. Ozon- 
ized clay is a remedy of intrinsic value. Useful in consolida- 
tion of the lungs from either a deposit of tubercle or effusion 
in inflammation ; in thickening of the oesophagus, or stricture, 
or in the same condition in the bronchi ; most efficient in fatty, 
starchy, or indurated liver; in yellow atrophy; decidedly effi- 
cacious in enlarged spleen. Its action is unexcelled in enlarged 
mesentery, or tabes mesenterica ; by endosmosis it annihilates 
the entire mass of tubercle; in ovarian, uterine, and other 
internal tumors it very speedily causes their absorption and 



REMEDIAL AGENTS. 855 

disappearance ; removes thickening of the walls of the stomach ; 
it will even discuss bony tumors or swellings ; removes by 
absorption the effusion in stiff or anchylosed joints ; speedily 
reduces enlarged testicles ; it will remove all tumors except the 
sebaceous, even the hardest fibroid, or most doughy fatty; and, 
above all, it is our only reliable remedy in cancer of the stomach, 
liver, bowels, kidneys, uterus, ovaries. Manage it judiciously, 
and the most astonishing results will be obtained. While using 
it, internal treatment must be pushed with vigor. 

Compound Ozonized Extract of Saxifraga. 

Formula. — Compound ozonized extract saxifraga is a combi- 
nation of the active principles of saxifraga, blue flag, tag alder, 
bittersweet, corydalis, poke root, and aromatics. Each fluid 
drachm contains five grains of iodide of potassa, and five of 
chlorate of carbon, subjected for one week to twelve atmo- 
spheres of ozone. The dose is one teaspoonful three times a 
day in cancer, tuberculse, and syphilis. The above constitutes 
the great national blood purifier, and is without a doubt the 
best alterative ever used in medicine, and is worthy of the 
reputation it has acquired, and can be used whenever a blood 
purifier is demanded. 

The discovery made in recent years that the micro-organisms, 
or disease-germs, tuberculae, cancer, syphilis, etc., are merely the 
degraded matter of our own or other's bodies, living and grow- 
ing in a lower stratum or sphere of existence, imperatively calls 
for an alterative like this, a blood scavenger capable of annihi- 
lating those germs in the blood, and then subsequently elimi- 
nating them from the body. In addition to its action as a 
blood purifier, it is remarkably efficient in chronic disease, 
in consolidation of the lungs, thickening of the walls of the 
stomach, dropsy, skin, and other diseases. It is a very active, 
energetic, and positive combination to promote absorption, heal 
old ulcers, break down adhesions, promote vital power, and 
cleanse the blood. To enumerate the different diseases in 
which it is efficacious, would take up an entire volume ; indeed, 
there are no chronic diseases that can exist long under its 
powerful action. 

Ozone Ointment. 

This can be made from lard, simple ointment, or, best of all, 
vaseline. Take several pounds of vaseline ointment ; keep it 
in a liquid condition for about a week by a water bath, and 
keep gradually running into it a stream of ozone gas ; remove 
from the fire and cool quickly, by packing the vessel holding 
it with ice and salt ; keep covered. 

One of the best of all ointments for dressing wounds, cuts, 
abrasions, cancers, ulcers of all varieties, erysipelas, boils. Its 



856 REMEDIAL AGENTS. 

great value consists in its antiseptic properties, destroying the 
bacteria and other diseased germs always found on ulcers and 
It should be spread on fine linen, and applied thrice daily, 
ores. It will heal the most obstinate ulcer. 

Other Salves. 

Other salves, or ointments, can be ozonized, and their thera- 
peutic power thereby increased. 

Ozonized Extract Eucalyptus. 

Prepared by distillation from fresh leaves, may be termed 
the great prophylactic, or preventative. It is prepared exclu- 
sively for external use. It may be used as a lotion to heal 
ulcers or sores. The best results are to be obtained from it as 
an eye wash or lotion in ophthalmia, and as an injection in 
gonorrhoea ; for the latter it is an almost instant cure. In all 
cases it is a preventative, if used early. Cleansing out the 
urethra with an injection of borax and water, and then throw- 
ing up one of the ozonized eucalyptus, at once destroys every 
gonorrhcea-germ with which it comes in contact. Its action is 
definite. It operates the same in the vagina, but it is some- 
what expensive for large injections. 

Kurchicine, or Hindoo Bitters. 

This active principle is obtained by distillation from the bark 
of holarrhena, antidygendinica, and then subjecting the extract 
to the action of ozone. 

It is a pure bitter tonic, with great range of action, very 
nearly equal to cinchona. It is an antidote to the whiskey 
habit. Dose, from one teaspoonful to a large tablespoonful 
every three hours, or more frequent. It promotes the appetite 
and aids digestion ; it stimulates the liver and thus regulates 
the bowels; it washes out the kidneys; has a beneficial action 
on the skin. It is especially useful in all diseases, or inertia of 
the liver. As a general tonic it braces up the vital powers, and 
. gives more stamina and power of endurance to the body. It 
will readily break up chills and fever, but has no influence on 
either the pulse or heat of the body. It can be used with 
great success in all cases of debility. 

Spermatorrhoea Pills. 

These pills are made up expressly for repressing and cut- 
ting off for the time being sexual desire, and stopping leakages, 
losses of semen, whether it be in the form of daily or nightly 
emissions, which are visible, or those unseen, into the urine 
and bladder ; leaving the sexual feeling strong and vigorous 
afterwards. For this purpose we have prepared the following 
invaluable prescription, an active principle from the green root 
of gelseminum, the active principle of the coca erythroxyion, 



REMEDIAL AGENTS. 857 

jerubabel. Highly ozonized. Made into three grain pills, one to 
be taken at 3 P. M., and two or three before retiring to bed. There 
should also be used the cold water hip-bath, and the rectum 
should be washed out with a half a pint or more of cold water 
before going to bed, and the right side reserved for sleep. They 
are most effectual in checking all leakages, and when discon- 
tinued after three or four weeks' use, the organs are more vigor- 
ous than before. 

Sexual Invigorator, 

Remedies that increase sexual power, or sexual stimulants. 
They are numerous, but mostly worthless, simply exciting the 
imagination. We have prepared the following, thoroughly 
ozonizing it : 

Formula. — The active principles of the true damiana ery- 
throxylon coca, cantharides, nux vomica. Dose, fifteen to thirty 
drops in a little water ; begin at three, six, and nine P. M. 
The small dose is generally sufficient. Its action may be said 
to be instantaneous and very salutary. It gives a man, either 
prematurely old, or really old, all the vigor and ardor of youth. 
In order to maintain its very beneficial action in impotency, 
the glycerite of kephaline should be used in connection with 
it. It leaves no injurious results. 

Compound Betin Pill, Ozonized. 

Prepared from the active principles of the red beet, ozonized. 
Each pill contains two grains of betin, half a grain of eaulo- 
phyllin, half a grain of the solid ^extract of hyoscyamus and 
mandrake, hardened with powdered myrrh. Dose, from one 
to two three times a day, for three or four days before the men- 
strual period. These pills have a most benign action on the 
uterus and ovaries ; keeps the uterine system healthy, active, 
and vigorous, so much so, that if used by ladies, they will 
maintain menstrual activity till well advanced in years, thus 
preventing this premature old age that is so common among 
ladies ; and also that shrinkage, withering, wrinkling. In other 
words, they maintain one of the most important of the vital 
functions of the female economy in activity, and with it the 
elasticity of youth; the mental vivacity and force; the smooth, 
dimpled skin, and other evidences of youth, in mature develop- 
ment. Married ladies, during the child-bearing period of life, 
should not use them. 

Cascara Sagrado, 

The powdered cascara, subjected to the influence of ozone, 
loses all its unpleasant taste, and becomes one of the most 
pleasant and reliable remedies for constipation, and where an 
efficient but gentle action of the bowels is desired. An inval- 



858 REMEDIAL AGENTS. 

uable remedy for ladies, children, or the aged. It can be ad- 
ministered in tea or coffee, without the knowledge of the user. 
It is put up in tablets, one square being designed for an adult, 
half of one for a child. It entirely supersedes the use of castor 
oil, rhubarb, senna, and other nauseous drugs. 

Valdivine. 

A remedy for tape-worm, prepared or isolated from the ka- 
meela, made from kousso, pomegranate root bark, punpkin seed, 
etc., and ozonized, we had presented some years ago, and now 
introduce it to the people at large as the only certain remedy 
for tape-worm, and the most reliable for their expulsion. No 
preparation is needed for its use ; it can be given at any time. 
To enable parties to obtain it fresh, and obtain the desired 
effect, we will mail it either to patients, physicians, or druggists. 

Santonine Lozenges. 

Take five ounces of pulverized white sugar ; one-quarter of 
an ounce of fine starch ; ten grains of finely-powdered traga- 
canth : mix the whole well. Then beat up to a dense froth 
the white of five eggs ; then add the above to them, and place 
in a porcelain vessel over a water bath, and stir constantly till 
the temperature reaches 100° F., until the mixture will no 
longer run from the spoon. Have ready a mixture of one 
hundred grains of fine pulverized sugar, and fifty grains of pure 
white santonine, pulverized, and incorporate this very thor- 
oughly with the mass, and pour out the entire quantity, and 
divide into one hundred lozenges or squares, each containing 
half a grain of santonine. They, each one, must be covered 
carefully over to protect them from the light. 

Other Ozonized Remedies. 

Liquid ozone, a powerful remedy for destroying disease- 
germs. Ozonized extract of sumbul, very efficacious in chorea 
and epilepsy. Ozonized extract of fucus vesiculosus, as an anti- 
fat remedy. Ozonized turpentine, an invaluable preparation 
locally in peritonitis, its application seldom failing in aiding a 
renewal of life and a rapid cure. 

Ozonized Syrup of Phytolacca Compound. 

Formula. — Take equal parts of the active principle of poke 
root, stillingia, yellow dock, helonias, menispermin, sassafras. 
Make a syrup, and add five grains of the iodide of potassa, and 
five of the chlorate of carbon to each drachm : mix, and submit 
the entire quantity to a pressure of twelve atmospheres of ozone 
gas for one week. Dose is one teaspoonful thrice daily. 

It is precisely the same in its action as the saxifraga extract. 
It forms simply a change. The saxifraga being the most active 



.REMEDIAL AGENTS. 859 

of the two. Invaluable as an alterative and blood purifier in cancer, 
syphilis, tuber cidse, chronic disease generally, and wherever an 
alterative is demanded. 

PARAFFINE DRESSING, OR SPLINTS. 

Paraffine has a guaranteed melting point of 130° F. It is 
found in the shops in odorless, whitish, or semi-transparent 
solid blocks, or bars ; and to facilitate its melting, should be 
shaved down, and the shavings put into a tin vessel, and this 
vessel placed in another containing boiling water ; liquefaction 
will soon take place. It is not advisable to place the paraffine 
on the fire, because if it gets into the fire it burns like grease, 
although a lighted match thrown into it would not make it 
either explode or burn, and there is little likelihood of any 
atmospheric temperature affecting it in the least possible degree. 
Paraffine dressing, or splints, do not shrink or contract in the 
least appreciable degree. This may seem strange, as all bodies 
contract in cooling, and paraffine forms no exception to the 
general rule. But this apparent contradiction may be explained 
by bearing in mind that the first part to cool is the external 
layer, the internal being kept warm, both by its own heat and 
the heat of the body, so that the cooling will take place from 
without inwards, and the contraction will take place toward 
the outer layer. As a consequence of this, it can be applied with 
a degree of firmness which it is necessary to maintain. When 
about to make a splint of paraffine, it is necessary to select some 
substance which will hold it, and which can be readily adapted 
to the limb, back, or other part of the body to which it is desirable 
that it be applied. The material which answers this purpose 
best is cotton-wool. Any kind will do, but the cotton wadding 
which is made up in sheets for quilts is the best. When about 
to make a splint, cut a piece of this sheet cotton wadding the 
necessary size. It may be either a single layer, or two or more, 
according to the object in view — -just enough to cover or en- 
velop the limb, or make a jacket. Then cut it neatly with 
scissors, do not tear it, and roll it up, and immerse it in the 
melted paraffine ; let it lay a few minutes in the liquid paraf- 
fine all submerged. After it is thoroughly saturated, have a 
tray or piece of oil-cloth ready, well oiled, so as to prevent any- 
thing adhering to it, into which the saturated cotton is to be 
turned and unrolled. After it has cooled to such an extent as 
to be borne by the back of the hand, it is ready to be applied 
to the part. The cooling does not take many minutes ; it will 
depend a little on the thickness of the layer. It is best to apply 
the paraffine right to the skin, without any intervening body. 
When the sheet of cotton-wool saturated with the paraffine is 
applied to the part, a bandage of gauze, or book muslin, should 



860 REMEDIAL AGENTS. 

be applied, so as to press the cotton firmly. This pressure 
causes a cohesion in the splint, and presses out any super- 
abundant paraffine. Then apply ice- water, which will cause 
the paraffine to harden at once. This substance can be manipu- 
lated to make almost any kind of splint or mechanical support — 
permanent splints, partial, any size, any form, with openings to 
dress wounds, or otherwise. If it is the desire to delay consoli- 
dation of the splint, retard cooling, apply no ice- water ; then it 
will take about ten minutes to cool. 

The hands of the operator get smeared with the paraffine ; 
but this can easily be removed by hot water, or by rubbing 
glycerine over the hands. 

When the splint has served its purpose, the paraffine can 
easily be taken out of it by immersing in boiling water, and 
at the same time cleansed of all foreign bodies, and be again 
ready for use, because all extraneous matter settles to the 
bottom, and the paraffine cakes on the top in cooling ; and if 
it is supposed that it is not cleansed enough by one application, 
it may be washed again. 

Paraffine, as a material for splints and mechanical support, 
possesses many advantages, as it is always handy, and can be 
got ready for use in a few minutes. It keeps well, and never 
undergoes any change, unless it is exposed to heat over 130° F. 
Water, moisture, or any discharge has no effect on it. It is most 
agreeable to the skin, and the quickness of consolidation is in 
the hands of the person applying it. It can be cut with a sharp 
knife into any shape. It is very light and pleasant to wear. It 
entirely supersedes the irritating, uncomfortable, weighty plas- 
ter of Paris, and is as cheap. It can be used in many fractures 
and deformities ; in synovitis, spinal curvature, club-foot, etc. 

PESSARIES, OR PASTILES. 

Pessaries, or pastiles are made of cocoa-nut butter, in moulds, 
sometimes quite small, in other cases moderately large, and of 
various shapes. Although this butter readily dissolves at the 
temperature of the human body, it is best for the easy intro- 
duction of them that they be made of an oval form, instead of 
the shape of an ordinary pessary. They are designed specially 
for diseases of the vagina, uterus, and its neck. In all cases, 
before they are introduced by the lady, the vagina should be 
thoroughly washed out with at least a quart injection of soap 
and water, or borax and water, or the permanganate potassa 
injection. The pastile introduced, patient in the recumbent 
position, with head low, and a pillow below the buttocks, which 
posture should be maintained for at least three or four hours, 
until the action of the medicine has been utilized on the parts. 
The best time for their introduction is after the patient has 



REMEDIAL AGENTS. 861 

retired for the night, so that the parts receive the full benefit 
of the drug. 

For Falling of the Womb. 

Hazeline, perchloride of iron, sulphate or acetate of alumina, 
of each five to ten grains to each pastile, and from thirty to sixty 
grains of the cocoa butter, acts like a charm upon the parts. A few 
weeks give a radical cure. 

Pruritus of Vulva. 

It is rare for the itching to extend up any great length; still, 
the action of borax, and other remedies in a pastile, is often of 
great utility. 

Catarrh and Ulceration of the Neck and Os Uteri 

Can be readily cured by cocoa-nut butter pessaries, and some of 
the following agents in the annexed proportions to each pessary 
of sixty grains of the butter : 

Iodide of potass, ten grains to each. Acid nitrite of mercury, 
one to two drops. Boracic acid, five to ten grains. Sulphuric 
acid, one to three drops. Acetate of zinc, three to five grains. 
Sulphate of hydrastin, five grains. Acetate of alumina, five to 
ten grains; and so with other agents. 

The blowing of triturations of bichloride of mercury on the 
neck is attended with danger, and never should be countenanced, 

Rigidity of the Os and Neck. 

In induration, thickening, and other forms of mechanical 
dysmenorrhcea, one-quarter of a grain of solid extract of bella- 
donna to sixty grains of the butter answers well, as it effectually 
paralyzes sphincter fibres, and thus relaxes. 

Thickening of Neck of Uterus, 

Take of iodide of potass — say, sixty grains ; cocoa-nut butter, 
one ounce : mix, and make into eight pastiles. One at bed-time. 

Intra-Uterine Catarrh. 

A catarrh of the internal lining membrane of the uterus. Is 
best treated with iodide of potass and iodide of lime internally, 
and once a month injecting the uterus with four ounces of dis- 
tilled water, with twenty grains of iodide potass, and carefully 
withdrawing every drop of the injection before removing the 
syringe. American ladies do not bear injecting the uterus well ; 
the law of reflex impressibility is too strong. There is danger 
from that, and from the fluid penetrating the uterine sinuses 
and causing death. It is now very highly recommended by 
European authorities to insert the cocoa-nut butter with iodide 
potass into the cavity of the uterus, made into the shape of a 
catheter, and permitting it to remain. For the reason above 
assigned it is not to be recommended. Such a practice may be 



862 REMEDIAL AGENTS. 

very serviceable in the male urethra in gonorrhoea, but risky 
in the extreme in the cavity of the uterus. 

Ulceration of Neck. 

Take the solid extract of bayberry, sulphate of hydrastin, and 
sulphate of quinine, one drachm of each to two ounces of cocoa- 
nut butter ; make into sixteen pastiles. Unexcelled in ulcera- 
tion. Or, 

Take borax, golden seal, bayberry, one drachm of each, and 
incorporate in two ounces of cocoa-nut butter, and make into 
sixteen pastiles. The articles are reduced to an impalpable 
powder, and act to some extent mechanically. 

To Relieve the Pain of Cancer. 

If the cancerous mass has not protruded from the os, pessa- 
ries can be used. Take thirty grains of pulverized opium ; one 
drachm of the solid extract of conium ; and twenty grains of 
the solid extract of hyoscyamus ; and two ounces of cocoa-nut 
butter. Make sixteen pessaries. Cleanse away discharge with 
permanganate injection, and introduce one frequently. 

Neuralgia of Uterus, 

Belladonna and quinine internally often fail to afford amelior- 
ation. The belladonna plaster over the loins, and rectal sup- 
positories of the same, even, fail, when the prompt use of the 
following will give instant relief: Take five grains of the extract 
of belladonna ; twenty of pulverized opium ; and two drachms 
of bromide of potass ; cocoa-nut butter sufficient to make six- 
teen pastiles. Insert one every four hours. 

Uterine Tumors. 

Take ergotine, iodide of potass, of each one drachm; cocoa- 
nut butter, two ounces, or less : mix. Make ten pessaries ; intro- 
duce at bed-time. Valuable in the absorption of uterine growths. Or, 

Take perchloride of iron, one drachm ; opium pulverized, 
thirty grains ; cocoa-nut butter, two ounces : mix, and run into 
the moulds ; use at bed-time. Valuable to cause spongy growths 
or polypi to disappear. 

Uterine Catarrh. 

Take of butter of cocoa a sufficient quantity to fill the tube of a 
No. 12 catheter (male), whose point has been filed off; add to it 
five grains of iodoform, and have a tube made to go inside the 
catheter capable of pressing it out. Then introduce it so charged 
into the cavity of the uterus ; let it remain a few mintutes until 
the butter begins to melt in the catheter. Then introduce the 
tube into the catheter, and push the iodoform butter into the 
cavity of the uterus, and withdraw the empty catheter. Keep 
patient on her back. It is very effectual. 



REMEDIAL AGENTS. 863 

PLASTERS AND LOCAL STIMULANTS. 

Local stimulants, or sedatives, are useful, not only in stimu- 
lating the skin, but are of great service where we desire to aid 
a renewal of life in any deep-seated part, or where we are desir- 
ous of promoting an absorption, or breaking down, or soothing. 

Croton Oil Liniment. 

Take a drachm of croton oil ; half an ounce of olive oil, and 
mix together. Valuable to produce a deep stimulating effect, as the 
relief of internal organs. 

Aconite, Belladonna, and Chloroform. 

Take two ounces of the tinctures of aconite ; two of belladonna, 
and two of chloroform : mix. Either rub on the painful part, or 
saturate a cloth, and then apply. Cover with oiled silk. Ex- 
tremely valuable in neuralgia, the chloroform being very penetrating 
carries the aconite and belladonna down to affected nerve. 

Oils of Hemlock, Cajeput, Sassafras. 

Take equal parts of the oils of hemlock, cajeput, sassafras, 
turpentine, and make a liniment, and apply. Useful in rheu- 
matic inflammation of joints. 

Capsicum Liniment. 

Take olive oil, four ounces; aqua ammonia, two ounces; oil 
of capsicum, thirty drops : mix. Rub over affected part. 

Stimulating Liniment. 

Soap liniment ; liniment of opium ; camphora liniment, of 
each, two ounces ; chloroform, an ounce : mix, and apply over 
the painful part. 

Caoutchouc Solution. 

Take a small piece of india rubber or gutta-percha, and dis- 
solve them in chloroform. A good protective solution. To be 
painted over parts that need protection. 

Collodion Paints. 

Take one ounce of collodion ; twenty drops of palm oil ; car- 
mine to color : mix. This makes an artificial skin that will not 
crack. So also does a few drops of glycerine added to collodion. 
Used as a varnish in cutaneous affections, superficial burns. 

Liniment of Lime Water 

Consists of equal parts of olive oil and lime-water. This is a 
good remedy for burns. 

Starch of Glycerine. 

Starch and glycerine are an excellent preparation for chapped 
hands. 



864 REMEDIAL AGENTS. 

Carbolic Acid. 

Take either six, eight, or ten ounces of olive oil, according to 
age of patient, and add one ounce of carbolic acid. Our best 
remedy in burns. 

Irritating Plaster, or Tar Plaster. 

Take of refined tar twenty-four ounces; Burgundy pitch, 
twelve ounces ; white pine turpentine, eight ounces; mandrake, 
root, blood root, poke root, and Indian turnip, of each one ounce, 
in very fine powder ; capsicum, same quantity. Melt the Bar- 
gundy pitch in a vessel in boiling water, same as a glue pot, with 
the white pine turpentine, and when melted add the tar. After 
that is thoroughly mixed then add the powders, and remove 
from the fire. Spread on leather the desired size, or put up in 
cans. The very best of all stimulating plasters. Very useful 
w r henever we need a local stimulant to break down and absorb 
lymph.. Invaluable in chronic pneumonia, pleurisy, phthisis, spinal 
irritation, hip disease. 

It may also be made in a hasty manner for instant use by 
simply adding pulverized mandrake, bloodroot, Indian turnip, 
and capsicum to refined tar sufficient to make a thick mass. 
But it is not so elegant, does not adhere well, is apt to move 
about and soil the linen. Being specially useful for chronic 
affections, the former is by far the best. If a hasty or immediate 
action is desired, over where it is designed to apply the plaster 
either a blister for six hours, or croton oil, or some other stimu- 
lant should be first applied. 

Warm Plaster. 

Take one part of cantharides plaster, Burgundy pitch, four- 
teen parts; pulverized cayenne pepper, two tablespoonfuls. Ex- 
cellent in the chest in colds, or where there are pleuritic or rheumatic 
pains about pluera or heart. 

Corn Plaster, 

Soak the foot with the corn in warm soda-water, and pare as 
close as possible ; then apply the following plaster : Take of 
aqua ammonia, two ounces ; yellow wax, two ounces ; and ace- 
tate of copper, one ounce. Melt the ammonia and wax together, 
and after removing them from the fire, add the copper just before 
they grow cold. Spread this on a piece of soft leather and apply. 
Remove in two weeks; corn usually drops out, or can be removed. 

Styptic Colloid. 

Take one hundred parts collodion ; ten parts of carbolic acid ; 
five parts of tannin ; five parts of benzoic acid from the gum : 
mix in the above order, and a perfect solution is effected. Paint 
over the part, and somewhat around the sound part. This 



REMEDIAL AGENTS. 865 

makes an excellent covering for sores, cuts, under which the 
wound rapidly heals. It is also excellent in burns, erysipelas, 
bunions, and wherever a good, strong covering is desired. 

Liquid Solvent for Corns. 

Put some pearlash in a wide-mouthed bottle ; place in a damp 
place till it forms an oil-like fluid. Then cork, and paint the 
corn with it as often as convenient until it is clean dissolved. 

Warts and Corns. 

Take half a pound of common potash ; eight ounces of water ; 
half an ounce of the extract of belladonna ; half an ounce of 
gum arabic, and enough of flour to form a paste. Keep well 
corked. Bathe the feet or hands, dry well, apply a piece of this 
to either the wart or corn, and let it remain five minutes. Then 
loosen the corn with a sharp knife, and it will drop out. Sub- 
sequently, keep wet with vinegar. 

Strengthening Plaster. 

Take three parts of hemlock gum ; one part white pine gum ; 
melt and strain. As it is cooling, a few drops of oil of capsicum 
can be added. Spread on leather and apply. 

Strengthening Plaster, 

Take litharge twenty-four parts ; white rosin, six parts ; yel- 
low wax and olive oil, three parts ; red oxide of iron, eight parts. 
Let the iron be rubbed with the oil, and the other ingredients 
added. Melt and mix the whole well together. Spread on leather 
the required size. Excellent for weakness and relaxation of parts. 

To Cure a Felon. 

A felon is simply an inflammation of the bones of the fingers, 
and can be arrested like all other forms of inflammation if seen 
early, by local stimulants, by some of the following plans : The 
immersing of the affected finger in strong lye as hot as can be 
borne, at frequent intervals ; or the oil of lobelia ; or the appli- 
cation of a blister over the part for six hours ; or the applica- 
tion of Venice turpentine ; or the ordinary spirits of turpentine. 
The object in view being to stimulate a renewal of life in the 
part. 

POULTICES. 

Poultices have various properties, act as local stimulants, and 
aid a renewal of life over the part to which they are applied. 
They are soft, emollient, and hold heat and moisture well, 
and are usually made of ingredients to meet some peculiar 
indication. 

Bran Poultice. 

Make a linen or cotton bag of the size requisite to cover the 

67 



866 REMEDIAL AGENTS. 

affected part, and fill it loosely with bran. Then either dip it 
into a pot of boiling water, or pour boiling water over it, till 
it is thoroughly moistened. Then place in a coarse towel, and 
wring it so that the water will not drop out of it. Then apply 
as hot as can be born. When nearly cold, remoisten and again 
apply. 

Bread and Milk Poultice. 

The bread and milk poultice is usually made by taking bread 
crumbs and covering with milk, and then boiling, keeping con- 
stantly stirring until it is reduced to a fine, soft mass, when it is 
to be removed and spread about half an inch thick on a piece 
of clean old linen, and applied : changed as soon as cold. It 
is of great utility in foul ulcers, or sores, in which diseased 
germs are abundant. Some grate mutton suit very fine, and 
introduce it into the same poultice, cooking all together. 

Linseed Meal Poultice. 

The best authority on this poultice lays down the following 
as the best method of making it : Scald the basin or bowl by 
pouring a little hot water into it, which throw out, and then 
add a small quantity of finely-ground linseed meal into the 
warm bowl ; pour a little boiling water on it, and stir it round 
briskly till they are well incorporated ; add a little more meal 
and a little more boiling water, and stir again, and so on. Let 
no lumps form, but stir actively until it is well worked, so that 
it adheres well together. Then spread it on a piece of soft 
linen, about a quarter of an inch thick, and so large that it may 
cover the affected part, and a little beyond. 

Slippery Elm Poultice 

Is made by boiling powdered slippery elm in water till it is 
of the required consistency to hold heat and moisture, and in 
sufficient quantity. The linseed and slippery elm poultices are 
those in general use, and are of the greatest utility for holding- 
heat, moisture, and being bland and healing. 

Onion Poultice. 

Onion poultice should be made of either garlic or the red 
onion roasted, then skinned and crushed, and applied hot. 
Some add mutton suet, as a layer, in shreds, to hold the mass 
together. Very useful in the catarrhal affections of children. 
Changed twice or thrice daily. 

The Alkaline Poultice 

Is made by adding bicarbonate of soda or potassa to the ordi- 
nary slippery elm poultice. Its great efficacy consists in the 
tendency of the alkali to discuss or hasten the breaking-down 
of lymph. Hence it is valuable in all swellings, thickenings, 



REMEDIAL AGENTS. 867 

Indurations, inflammations, but usually very painful ; that, of 
course, depends greatly on the amount of alkali added. As a 
rule, if applied, let it be during the day, and some soothing 
anodyne poultice at night. The quantity of the alkali added 
to each poultice will depend on its size and the object to be at- 
tained — speedy or slow. It is usually very active in promptly 
bringing about suppuration, or in getting rid of the lymph. 
It should be discontinued the moment the object is attained. 

The Antiseptic, or Yeast Poultice. 

The antiseptic, or yeast poultice, may be made of brewers' yeast 
and Indian meal, but it is better to make it of all, or some of 
the following ingredients : Pulverized charcoal, wild indigo, 
slippery elm, linseed meal, brewers' yeast, carbolic acid and 
cayenne pepper. Make a mass by, say, one tablespoonful of char- 
coal, one of wild indigo, two of linseed meal, half a teaspoonful 
of cayenne pepper, and five or ten grains of carbolic acid : mix 
with brewers' yeast ; increase quantity with size of poultice. It 
should be at least an inch thick. It is of great efficacy in threat- 
ened gangrene, or where we are desirous of establishing a line 
of demarcation in certain states ; if for the latter, increase the 
quantity of the capsicum, same as the charcoal. It should, 
like all other poultices, be a soft pultaceous mass, and be changed 
twice or thrice daily. 

Mustard Poultice. 

This is mixing pulverized mustard with hot water and apply- 
ing. 

Medicated Poultices. 

Pulverized opium, or tincture opium, or fluid extract of con- 
ium, or other anodynes can be added to the ordinary slippery 
elm or linseed poultice. 

Lobelia Poultice. 

Made by stewing the plant or powder, adding in either elm 
or linseed meal. 

Carrot Poutice. 

Boil the red carrots till they are quite soft, then mash them 
into a pulp. 

Cranberry Poultice. 

Cranberry poultice in same manner. Both very useful in 
foul, bad smelling sores, cancers, and the like. 

Charcoal Poultice. 

Take linseed meal, one-half pound ; pulverized charcoal, two 
ounces ; boiling water to make it of sufficient consistency. When 
cool enough, apply. Change often. It corrects and prevents the 
tendency to mortification. 



868 REMEDIAL AGENTS. 

Indian Turnip Poultice. 

Take the pulverized root, and add in quantity desired, to slip- 
pery elm. Valuable poultice for joints and swellings. 

Vinegar Poultice. 

Soak bread in vinegar and apply cold. For bruises, extrava- 
sations, black eyes. 

Alum Poultice. 

Alum poultice is made by beating pulverized alum in white of 
raw egg, until they coagulate. Good for chilblains and for stimu- 
lating absorption about the eyes. Apply on linen and cover 
with a piece of fine muslin. 

PRESERVATION OF THE TEETH. 

The premature decay of the teeth in our country is proverbial, 
and its causes are diversified and widespread, and embrace some 
of the following : such as a genuine deficiency of bone elements 
in the blood, owing to their absence in the food ; the use of mer- 
cury in medical practice ; the use of sweets, in which glucose 
enters so largely ; ices, hot and cold drinks, which crack the 
enamel of the teeth ; the very general inattention to the proper 
care of the teeth, in not cleansing them properly after meals ; 
the use of deleterious tooth powders, which are chiefly com- 
posed of pulverized pumice-stone and orris-root, which grind 
off the enamel; disease-germs in the mouth and their micrococci 
are destructive to the dentine ; the filling of cavities in decayed 
teeth with amalgams which are all loaded with mercury. Some 
think that the great increase of degeneration is due to early pre- 
cocity ; the increase of nervous disease,which corresponds to the 
deterioration of the teeth, influencing, and in a measure causing 
the other ; but perhaps the greatest of all causes is the over- 
stimulating the nerve power by a too early and onerous edu- 
cation, causiug a heavy drain upon the phosphatic elements, 
and a defect in the assimilation of bony matter of the teeth. 

Nearly all the above causes admit of removal ; the use of 
tooth powders and amalgams for filling should be positively 
avoided, and a natural method of preservation resorted to. 

The Gem of Tooth Washes and Preservers. 

The bark of the quillaya, a tree that grows abundantly in 
Chili, contains a saponaceous principle which is extensively 
used in the arts for its powerful cleansing properties. A decoc- 
tion made by placing a small piece of the bark in water and soak- 
ing over night will, if applied to grease spots and stains at once 
remove them, leaving the cloth as if it were new ; applied to 
the hair and scalp it promptly removes dandruff and other 
affections of the hair, and when applied to the teeth, not only 



REMEDIAL AGENTS. 869 

cleanses, but imparts to them the whiteness of the finest ivory. 
The preparation that we recommend for use in every family and 
by every individual, young and old, is. the fluid extract, a small 
quantity added to water and used, will preserve the teeth like 
a row of pearls till a good old age. It should supersede all 
washes, powders, and other deleterious nostrums. 

Toothache. 

Nitrite of amyl, or a one per cent, solution of nitroglycerine, 
is most effectual in toothache. Simply steep a piece of cotton- 
wool with either, and introduce it into the painful cavity ; or fill 
the cavity with a few pieces of chloral hydrate, and allow it to 
dissolve ; a lotion of aconite, belladonna, and chloroform is also 
excellent ; also, oil of cloves and chloroform. 

White Teeth. 

Take either chalk, or numice stone, pulverized, two ounces ; 
orris root, pulverized, one ounce ; gum myrrh, a quarter of an 
ounce ; pulverized sugar, one ounce ; pulverized Peruvian bark, 
half an ounce ; rose pink, enough to color. Use with tooth 
brush. It whitens the teeth, hardens the gums, imparts a sweet odor 
to the breath. 

Oralina. 

This is an agreeable preparation as a toilet article for cleans- 
ing the mouth and teeth, and imparting a pleasant fragrance 
to the breath. It is stimulant, astringent, and antacid. It is 
thus prepared : Take of either pulverized pumice stone, or pre- 
cipitated chalk, four ounces ; one ounce pulverized cuttle-fish 
bone ; half an ounce of pulverized boracic acid ; orris root, one 
ounce; a few drops of otto of roses: mix, and apply with a brush ; 
or diluted with water, as a mouth wash. It is a wholesome de- 
tergent for general use, and contains nothing injurious to the 
teeth. 

White Filling for Teeth. 

In order to aid in discarding the very reprehensible practice 
of filling the cavities of decayed teeth with amalgam, which 
contains mercury, we give the following, which is excellent : 

First clean out the cavity, dry it well, then drop in a drop of 
a solution of gutta-percha in chloroform. Then place on a piece 
of glass a small piece of fused chloride of zinc ; allow it to deli- 
quesce ; then add glass reduced to an impalpable powder, enough 
to make a thick paste: mix rapidly, as it sets quickly, and fill 
neatly into the cavity. Or a more permanent white stopping 
can be made by mixing the glass with the oxide of zinc and 
pyrophosphoric acid. In the above method the nerve of the 
tooth need not be destroyed. 



870 REMEDIAL AGENTS. 

PURGATIVES, OR CATHARTICS. 

Purgatives, or cathartics, are a class of remedies that produce 
repeated evacuations from the bowels. They operate in a vari- 
ety of ways. Some by irritating the mucous coat of the bowels, 
thus causing increased action of the exhalent, or mucous follicles ; 
others by acting upon the serous coat ; while another, and the 
best class, promote a free flow of bile from the liver. The last 
are least depleting. 

Salines. 

Take two quarts of water just off the boil; eight ounces 
of Epsom salts ; four ounces of Glauber salts ; two ounces of 
Rochelle salts ; one drachm of saltpetre ; and one drachm of 
sulphuric acid : mix. One, or more, tablespoonfuls in half a 
teacupful of water, either before retiring, or else very early in 
the morning. Every family should keep the mixture. It is 
the best of all saline cathartics. 

White Liquid Physic. 

Take a pint and a half of water ; sulphate of soda, half a 
pound ; nitromuriatic acid, two ounces ; and powdered alum, 
one drachm : mix. Dose, six drops in a wineglassful of water 
one, two, or three times a day, as indicated. It acts as a cooling 
purgative, allays nausea, vomiting; very valuable in liver disease, 
dysentery, jaundice, malarial fevers ; also acts well on the blood. 

Epsom, Glauber, Rochelle Salts. 

A teaspoonful of either, added to enough water to dissolve, 
and taken as indicated ; or they can be combined. A mild 
cathartic. 

Epsom Salts and Sulphuric Acid. 

A teaspoonful of Epson salts to half a tumbler of water ; then 
add fifteen drops of aromatic sulphuric acid for a dose. 

Phosphate of Soda. 

One teaspoonful of phosphate of soda to half a teacupful of 
sassafras tea, and repeat ; is an excellent purgative, by causing 
a free flow of bile. 

Senna and Prunes. 

Make an infusion over-night, by pouring a pint of boilng 
water upon two ounces of senna leaves. By the morning it 
will have evaporated down to a half-pint; if not, boil down to 
that quantity ; then strain very carefully. Take this half-pint 
infusion, and add to one pound of Turkey prunes, boil or sim- 
mer in a close vessel down to a pulp, then add sugar enough to 
make a jam or jelly to preserve ; flavor with oil of lemon ; put 
away as a preserve. One tablespoonful, more or less, will act 



REMEDIAL AGENTS. 871 

as a gentle laxative. The taste of the senna is entirely dis- 
guised, so the patient need not know that it is intended as a 
cathartic. Best taken at night. Useful for habitual constipation. 

Sulphur and Magnesia. 

Take carbonate of magnesia, twenty grains ; bicarbonate of 
potassa, ten grains; sulphur, twenty-five grains; pulverized gin- 
ger, five grains : mix in a tumblerful of milk, and take very 
early in the morning. 

Compound Powder of Jalap. 

Take compound powder of jalap and senna, twenty grains; 
croton oil, one drop : mix, and rub up well, and give frequently 
till the bowels open freely, in inflammation of the brain. 

Elaterin, 

Take of the liquor ammonia acetatis, one ounce ; sweet spirits 
of nitre, half an ounce ; syrup of ginger, half an ounce ; elaterin, 
one grain : mix. Dose, one teaspoonful every two hours until 
the bowels are freely moved, in dropsy, and afterwards once or 
twice a day. The pill elaterin contains one-twelfth of a grain, 
and is also a very active purgative in dropsical effusions. 

Mandrake. 

Take of pulverized crude mandrake, thirty grains ; cream of 
tartar, half an ounce ; nitrate of potassa, one drachm : mix. 
Make ten powders ; take one night and morning. Mandrake 
excites an acrid secretion from the liver, and never should be 
given alone, as it is highly dangerous. The compound vege- 
table antibilious pill is also a good form ; a good cathartic when 
the liver is torpid. 

Castor Oil. 

The taste of castor oil may be destroyed by mixing it with a 
teacupful of well-salted and peppered beef tea ; or by mixing 
it with glycerine, and flavoring it with cinnamon-water. 

Sulphur. 

Take one ounce of the sulphate of magnesia ; one drachm of 
the sulphate of iron ; two drachms of aromatic sulphuric acid ; 
compound tincture of gentian, one ounce ; water, three ounces : 
mix Dose, two tablespoonfuls once or twice daily in water. 
Excellent in skin diseases, or in piles with very torpid liver. 

REFLEX SEDATIVES. 

The fact being established that the medulla oblongata, spinal 
cord, and the co-ordinating chemical centre at the base of the 
brain are true reflex centres, a classification or enumeration of 
a special class of drugs under this head is imperative. 



872 REMEDIAL AGENTS. 

Sumbul and Bromide of Potass. 

Take four ounces of the fluid extract of musk root ; one ounce 
of bromide of potassa ; three drachms of bicarbonate of potassa : 
mix. As soon as the patient can swallow in lock-jaw, one tea- 
spoonful every two hours. Useful in all reflex states similar to 
lock-jaw. 

Calabar Bean. 

The tincture of calabar bean is best given alone, in from half 
to whole teaspoonful doses every two hours, with the above. 
Spasm, lock-jaw. 

Bromide of Potass. 

Take six ounces either of cinnamon or camphor- w T ater ; two 
ounces of bromide of potassa ; four drachms of bromide of am- 
monia ; half an ounce of bicarbonate potassa ; one ounce of the 
tincture of calabar bean ; and thirty drops of tincture of black- 
snake root, aconite, belladonna : mix. One teaspoon at least 
every three hours, or more frequent. Of decided efficacy in asthma, 
angina pectoris, whooping-cough, convulsion, epilepsy, hysteria. 

Bromide of Ammonia. 

Take four ounces of cinnamon-water, to which add half an 
ounce of bromide of ammonium, and two drachms of the chlo- 
rate of potass : mix. Dose, a teaspoonful every three hours. 
Valuable for infants in cases of spasm. 

Lobelia. 

Take thirty grains of pulverized lobelia leaves fresh ; the same 
quantity of the solid extract of hyoscyamus pulverized; the 
same of capsicum : mix. Make into thirty pills. Dose, one or 
two every three hours. They are of remarkable utility in all forms 
of nervous irritability or twitchings. 

Scullcap. 

Take equal parts of the fluid extract of scullcap, American 
valerian (ladies' slipper), and catnip: mix all. Dose, from fif- 
teen to thirty drops every two hours. Is valuable for nervous 
i rr itability, headache, neuralgia, nervousness. 

SUPPOSITORIES. 

Suppositories are a class of medicinal compounds in which 
remedies are introduced, mixed, incorporated, or dissolved in 
cocoa-nut butter and run into pear-shaped moulds usually con- 
taining either thirty or sixty grains in all, and introduced into 
the rectum at stated intervals for special maladies. This butter 
melts at the ordinary temperature of the body, and they should 
not be made large, as it is the object that they be retained some 
time. 



REMEDIAL AGENTS. 873 

Opium and Tannin. 

Take of cocoanut butter thirty or sixty grains ; opium pul- 
verized, one grain ; tannin, five grains : mix, and run in mould. 
Valuable in diarrhoea and dysentery. 

Belladonna and Opium. 

Take four grains of the extract of belladonna; eight of pul- 
verized opium, and a sufficient quantity of the cocoa-nut butter 
to make eight suppositories : mix, run into moulds. One at bed- 
time, or more frequent in neuralgia of the uterus, painful men- 
struation. 

Lobelia. 

Take twenty drops of the oil of lobelia; thirty of the oil of 
capsicum ; a sufficient quantity of cocoa-nut butter to make 
eight suppositories of proper size : mix. Use in epileptic fits, con- 
vulsions, tetanus. 

Perchloride of Iron. 

Incorporate two drachms of Monsul's salt perchloride of iron 
in a sufficient quantity of cocoa-nut butter to make six sup- 
positories. Opium can be added if desired. Extremely valuable 
in bleeding piles. One introduced every night at bed-time, rap- 
idly, shrivels them up and they disappear. 

Iodide of Potass. 

Take two drachms of iodide of potass, four grains of extract 
of belladonna, and eight of opium. Mix in a sufficient quan- 
tity of cocoanut butter and make eight suppositories. Empty 
the rectum first with a teacupful of cold water thrown up, and 
as soon as evacuated insert suppository; best to be done before 
retiring. Exceedingly valuable in enlarged prostate. 

To substitute bromide of potassa instead of the iodide would 
render it useful in nocturnal emissions. 

Lobelia, Capsicum, Valerian. 

Take of the resenoids of lobelia, capsicum, and valerian, say, 
two drachms of each, add sufficient quantity of cocoanut but- 
ter to make eight thirty-grain suppositories. Insert one every 
half hour in lock-jaw till the mouth opens freely. 

Opium and Hyoscyamus, 

Take twenty grains of pulverized opium, ten of pulverized 
extract of hyoscyamus, and twenty grains of camphor. Incor- 
porate in melted cocoa-nut butter sufficient quantity, and divide 
into fifteen suppositories. Insert one every half hour in acute 
gastritis, peritonitis, and metritis. Extremely valuable when the 
stomach rejects everything. The same could be made, and 
conium introduced, instead of the hyoscyamus. 



874 REMEDIAL AGENTS. 

Ergotine. 

Take twenty grains of ergotine, ten of opium, and thirty ot 
iodide of potass. Incorporate in cocoanut butter a sufficient 
quantity, and make into twenty suppositories. Use one three 
times a day. Very valuable to absorb uterine fibroids. 

Lobelia and Belladonna. 

Take five grains of the solid extract of belladonna ; twenty 
grains, by weight, of the oleo resin of lobelia. Add to a suffi- 
cient quantity of cocoa-nut butter to make fifteen suppositories. 
Insert one every hour in rigidity of the os uteri. Invaluable. 

UTERINE REMEDIES. 

There are a certain class of remedies that act upon the lower 
portion of the spinal cord, and the organs contained in the 
pelvis, more especially the uterus. For example, the infusion, 
oil, and even the water of fennel seeds, contract the broad liga- 
ments of the womb, and is very useful in falling of that organ. 
Then, again, senecio, helonias, bethroot, high-cranberry, vibur- 
num, cohosh, etc., increase the vital activity of the uterus, and 
promote a healthy uterine action ; betin, cotton root, borax, 
sabina, cause a determination of blood to that organ ; quinine, 
capsicum, mistletoe, corn smut, ergot, act as stimulants to the 
uterus; whereas all the acro-narcotics, such as belladonna, stra- 
monium, are withering sedatives to this very vital organ, and 
so, also, with bromide of potassa; so that in this region we have, 
as it were, a special class of remedies to deal with. 

Viburnum Compound. 

Tak one ounce of pulverized black haw; one of helonias; 
one of bethroot ; add them to a pint of sherry wine ; let them 
steep about two weeks, then use. Dose, from one to two table- 
spoonfuls thrice daily. A decided uterine tonic and alterative. 
It is a preventative to threatened miscarriage ; relieves after- 
pains, or uterine cramp. 

Viburnum, Valerian, Etc. 

Take of pulverized black haw, burdock seeds, valerian, skunk 
cabbage, skullcap, capsicum, of each half an ounce. Macerate 
in half a pint of Holland gin for a week. Dose, a small tea- 
spoonful, as indicated, in uterine pain of a neuralgic character. 
Or, 

Take an ounce each, of pulverized cramp bark, skunk cab- 
bage, skullcap, and half an ounce of capsicum to one pint of 
sherry wine. Dose, same as the above, and for the same affection. 

Wine of Partridgeberry. 

Take one ounce of crushed partridgeberry, helonias, high 



REMEDIAL AGENTS. 875 

cranberry, blue cohosh, and senecio. Add them to one quart of 
sherry wine. Macerate for about one month, then filter. Dose, 
one to two tablespoonfuls before meals. Good uterine invigorator. 

Mother's Cordial. 

Take four ounces of starwort ; four ounces of high cranberry ; 
four ounces of blue cohosh ; and one pound of partridgeberry. 
Grind them all together, and cover them with strong alcohol for 
two weeks. Then add three pints of alcohol, and strain off the 
same; which set aside. Then boil the ground mass with two 
quarts of water, so as to extract all its properties, and boil down 
to two pints, then strain. Add to this watery extract two pounds 
of sugar, and evaporate to five pints. When cool, add the three 
pints of tincture first obtained. Flavor with oil of sassafras. 
Dose, from one to two teaspoonfuls every three hours in uterine 
weakness. 

VERMIFUGE, OR WORM REMEDIES. 

In the alimentary canal of man there are some thirty-four 
different kinds of worms found ; but they can be reduced to 
three classes for the purpose of treatment, or for the operation 
of a class of remedies called vermifuges, which either narcotize, 
paralyze, poison, or destroy them mechanically. The ascarides, 
in the rectum and colon ; the lumbricoides, in the small intes- 
tine ; and taenia solium, or tapeworm, occupying a part of the 
thirty-two feet of the bowel. 

For the Expulsion of the Seat- Worm. 

Use an enemata, morning and night, of any bitter infusion, as 
quassia, or golden seal, or gentian, or even cold water, and in- 
ternally some tonic, as cinchona. 

For the Lumbricoides, or Round Worm, 

Santonine is the remedy. Select that which is of a pure white 
color ; never use the yellow, as it is inert ; air and light decom- 
pose it, so keep it covered. It is incompatible with all other 
remedies, must be given alone, or in white of egg, in lozenges, 
or rubbed up in sugar. Warm water dissolves it ; it is tasteless. 
Must not be given to American children in large doses, as it 
tends to irritate the brain, cause color-blindness, convulsions, 
death. Children of parents of low civilization bear it well, and 
can take doses of four or five grains ; but one grain every night 
at bed-time, or every other night, is a sufficient dose for any of 
our children. It should be followed in the morning with some 
agent to move the bowels, as the cascara, or neutralizing mix- 
ture, or oil. 

For the Tape Worm. 

The infusions of kameela, male fern, kousso, pomegranate 



876 REMEDIAL AGENTS. 

root bark, pumpkin seeds, are all useful, but unreliable. We 
prepare an active principle from their oils and extracts by 
ozone, which never fails, and is the best remedy ever used, as 
it is unfailing in its efficacy, always brings the worm, and that 
is valdevine. 

MINERAL-WATER BATHS. 

Mineral-water baths have been in use since the earliest ages, 
and they have existed in all parts of the world, in public and 
private places, chiefly near wells or springs which are believed 
to possess healing properties. Like many other important reme- 
dies, their virtues have been regarded with superstition at one 
time, and at another with blind empiricism. The physician of 
the present day is keenly alive to the utility of bathing, in all 
diseases, especially with medicated agents ; he duly appreciates 
their value, their therapeutic power, in aiding the vital forces 
to recovery in disease. 

A mineral-water bath is merely one of nature's chemical 
compounds — a complicated, natural medicine, containing vari- 
ous salts and gases blended together. The different ingredients 
are generally derived from the soil or rocks through which the 
water passes; and they consist chiefly of chloride of sodium, 
sulphate and carbonate of soda, sulphate and carbonate of mag- 
nesium, some salt of iron, bromine, iodine, chlorine, organic 
matter, and more or less of free gases, sulphuretted hydrogen, 
carbonic acid, nitrogen, oxygen, ozone. The organic matter 
usually consists of metallic salts. Such waters are sometimes 
met with cold, in other cases hot, and the cause of their existing 
in a hot state may be due to the internal heat of the globe, or 
to electricity generated in their formation, or to volcanic agency ; 
or perhaps, in the larger proportion, to chemical change that 
takes place in them. There are numerous hot or boiling springs, 
as those in Arkansas, the Yellow Stone Valley, in New Mexico, 
the Geysers or hot springs of Iceland, and many others cele- 
brated for their rare medicinal property ; bat, as a rule, mineral- 
waters are mostly met with cold, or slightly increased in tem- 
perature. 

Mineral-waters are used both internally and applied extern- 
ally. Their internal administration is chiefly for the purpose 
of increasing the activity of the depurating or eliminating 
organs, hastening and promoting digestion, stimulating the 
liver and bowels, destroying disease germinal matter in the 
blood, dissolving calculi, discussing or absorbing tumors, cleans- 
ing and vitalizing the cobwebbed brain, diluting and purifying 
the blood, increasing secretion and excretion, and eliminating 
morbid matter from the blood. They all stimulate the cuta- 
neous and visceral circulation, and cause a rejuvenation of the 



REMEDIAL AGENTS. 877 

entire body. Their special effect will depend on their chemical 
composition, and some little on their locality, nature of climate, 
temperature, etc., etc. 

Mineral-waters are best adapted for the cure of chronic dis- 
eases ; hence the class of patients that are likely to derive most 
benefit are those affected with skin affections, tubercular, can- 
cerous, and syphilitic diseases in all their varied forms; tumors, 
ulcers, rickets, stiff joints, gout, rheumatism, sciatic, neuralgia; 
liver and kidney diseases ; inertia of the bowels, especially the 
colon and rectum ; old cases of paralysis ; Bright's disease ; 
mercurial contamination ; ansemia of brain and cord, as hyste- 
ria, hypochondriasis, epilepsy, chorea, mania ; diseases of the 
generative organs of both sexes, as impotency, sterility; all 
disorders of the uterus, as displacements, tumors, leucorrhoea ; 
and those incidental to the male, dropsies, etc. 

Cases of acute disease, in the vicinity of those springs, are 
sometimes treated with the waters by sponging, and otherwise. 
But very great care should be exercised in their use, especially 
in the young or aged, so that their chemical composition be 
not contra-indicated in the disease. 

For the cure of obstinate chronic disease, cases beyond the 
reach of ordinary remedies, they can be used at all seasons of 
the year, and in all cases they should be persevered, with for 
several months, and in some cases for years ; usually a few weeks 
afford a remarkable amelioration. Still, it is best not to expect 
much for some time; and the patient should be cautioned against 
the popular error, that the more frequent and longer they are 
used, the more speedy the recovery ; this is not the case. The 
best plan is to follow the advice of some old, experienced physi- 
cian in their neighborhood. It is not our province to advertise 
the waters of Saratoga, Bedford, West Virginia, Arkansas, Cali- 
fornia, or Mexico ; but we would, in order to exhibit their great 
value, solicit attention to the most obscure, unknown spring in 
the United States or Canadas — namely, the sulphur springs of 
Mount Clements, Michigan, a little town surrounded by wooded 
hills, four hundred and fifty feet above the level of the sea, on 
Lake St. Clair, twenty-two miles from Detroit. 

The springs here are of inestimable value. Their waters 
are of the sulphurous kind, and have the odor of rotten eggs, 
owing to their very heavy impregnation with sulphuretted 
hydrogen gas, each gallon containing twenty-five cubic inches, 
with heavy quantites of calcium, potassa, sodium, magnesia, 
iodine, bromine. The waters are very sparkling, owing to the 
large amount of carbonic acid gas they contain. They are 
highly vitalized. 

These properties in the waters give them a remarkable thera- 
peutic action. They render them great scavengers of diseased 



878 • REMEDIAL AGENTS. 

blood, because the different agents are in great abundance 
through them, and of the most active description. Indeed, the 
waters are so highly charged with those invaluable remedials, 
that they are incapable of holding them, and as a result the 
atmosphere of the entire town is saturated with their properties. 
This dissemination renders the town a desirable residence for 
invalids, without ever drinking the water or taking a bath. 

The (Jlysmic natural mineral spring water of Waukesha, 
Wisconsin, and those of Virginia, are unexcelled in their reme- 
dial power, being much superior in their medicinal properties 
to any in Europe. They are indispensable adjuvants in the 
care of Bright's disease, diabetes, inflammation of the bladder 
or kidneys, catarrh of the bladder, congestion of the kidneys. 

For nearly a century the cold and thermal springs of Vir- 
ginia have been favorably known, but of late years their merits 
have been fully developed. Owing to the great amount of 
iodine and bromine with which the waters are impregnated, 
they are held in very high esteem by invalids, especially those 
suffering from chronic disease. Analysis of these waters, made 
by Prof. W. Clayton, M. D., of Newark, West Virginia, one of 
the best analytical chemists of the country, demonstrates con- 
clusively that in wealth of medicinal matter they far surpass 
any of the other regions of the country ; containing every in- 
gredient found in other springs, in a much larger amount, and 
more heavily impregnated with the iodine, bromine salts. 

They are unsurpassed, either in this country or Europe, for 
all classes of invalids ; besides, the hotel facilities and comforts 
in those Virginia resorts are superb, and the accommodations 
for bathing are excellent, there being good douche, shower,vapor, 
reclining, swimming, and chair baths. By means of the latter, 
worked with a crane, a helpless invalid is lowered into and 
raised from the water. 

The baths are used every day, or every other day, never near, 
nor afterameal, and the patient remains in them fifteen, thirty, 
or forty-five minutes, and are usually followed by shampooing 
or massage, according to the disease. 

It will be readily perceived from the chemical composition 
of the waters that they have a remarkable bracing effect on the 
nerve-centres, stimulating the powers of life to increased activ- 
ity. 

In disease of the skin, tubercle, cancer, syphilis, mercurial 
disease, they act with wonderful power in getting rid of morbid 
matter, aid in the elimination of carbolic acid gas by the lungs, 
and skin, as well as of urea and uric acid by the kidneys. 

They are very useful in gout, rheumatism, plethora, paralysis, 
germ diseases, and the arrest and formation of lactic and butyric 
fermentation, and the development of lithiate of soda. As the 



REMEDIAL AGENTS. 879 

waters are alterative, aperient, antiseptic, and stimulant, those 
that are suffering from liver disease, bowel torpor, and enlarge- 
ment, induration of glands, lupoid ulcers, and all skin affec- 
tions, are cured. They also prove very valuable in uterine dis- 
ease, remove inflammatory affections, rectify displacements, cor- 
rect derangements of the menstrual functions. Cases could 
be cited in which they have promoted the absorption of large 
fibroid tumors of the uterus and ovaries, as well as of the mam- 
mary gland. 

Those waters are invaluable in all chronic diseases, impart 
new life to the nerves, sooth muscular and neuralgic pains, re- 
move torpor of any organ, tranquilize the nervous system, im- 
prove digestion, stamp out dyspepsia, stimulate the circulation, 
relieve bronchial affections. The above and numerous other 
complaints that medicine fails to reach, can be cured by the 
mineral waters of one of the most unpretending and unknown 
springs in the United States, where thousands of invalids are 
annually cured. 

TONICS. 

Tonics are medicines that produce gentle and permanent in- 
crease of vital force. They are indicated in all cases of debility. 
They invigorate by increasing the energy of the stomach, by 
promoting an appetite, improving digestion, stimulating the 
circulation, and by their bracing action upon the whole body. 
They are either pure bitters, aromatic, or mineral agents, and 
in some cases have a definite action upon special parts of the 
organism. 

Quinine, Hydrastin, Iron by Hydrogen, Nux. 

Take thirty grains of sulphate of quinine; thirty grains of 
sulphate of hydrastin ; thirty grains of iron by hydrogen ; and 
eight grains of the extract of nux vomica: mix. Make thirty 
pills. Dose, two every three hours. Very serviceable in ansemia 
from debility, incipient paralysis, or any condition of debility. 

Iron Acetic Tincture. 

Take one pound of small lath nails, and cover with cider 
vinegar ; let them steep two weeks, and then filter. Or steel 
scraps, or filings, may be used. This makes the acetic tincture 
of iron superior to dialyzed iron. Dose, from half a teaspoonful 
to a teaspoonful in a wineglassful of water. In ansemia, chlorosis, 
suppression of the mensis, want of appetite, and debility. 

Muriated Tincture of Iron 

Is made by putting scraps of iron or steel into dilute muriatic 
acid. It is given in small doses, ten to fifteen drops, in water 
thrice daily, but is not near so efficacious as the acetic tincture 
of iron. 



880 REMEDIAL AGENTS. 

Phosphorus, 

A constituent of the brain and bone of the body of animals. 
Is used in medicine as a tonic, in the form of water, infusion, 
tincture; mixed in mutton suet, made into pills; in oil and 
other forms — all probably more injurious than beneficial to the 
human body, causing fatty degeneration of the heart. The 
dilute acid, the glycerite of kephaline, and the hypophosphites 
of soda and lime being free from that abnoxious property. 

Dilute Phosphoric Acid. 

Ten to fifteen drops in a little water after meals. A good 
brain tonic. 

Glycerite of Kephaline. 

Ten to fifteen drops in a little water after meals. The only 
true brain food,vitalizing tonic; increases vigor; restores the bouyancy 
of youth ; increases the mental power. (See Ozonized Kephaline.) 
Glycerite of Ozone. 

Fifteen to thirty drops; still more powerful tonic. (See Ozon- 
ized Remedies) 

Cinchona and Phosphoric Acid. 

Take two ounces of the compound tincture of cinchona ; two 
ounces of glycerine ; dilute phosphoric acid, half an ounce : 
mix. A teaspoonful after meals in a little water. A good tonic. 

Tonic Wine. 

Take of freshly pulverized comfrey root; Solomon's seal; 
helonias root; chammomile flowers; columbo root; gentian 
root ; coriander seed ; and sassafras bark, one ounce of each. 
Add the whole to one quart of good sherry, and let them steep 
one month ; then strain. Dose from a teaspoonful up to a table- 
spoonful before meals. An excellent tonic. 

After the removal of the first, if the properties are not suffi- 
ciently extracted, a pint more sherry could be added and 
strained off, which is not so strong as the first. This prepara- 
tion from the crude articles is much superior to any prepared 
from fluid extracts. 

Brandy and Iron. 

Take one pint of brandy, to which add thirty grains of qui- 
nine, one ounce of golden seal, and half an ounce of the phos- 
phate of iron : mix. Shake well, and take two tablespoonfuls 
before meals. A good tonic to create an appetite, and aid in 
blood formation. 

A Simple Tonic. 

Quassia chips, subjected to infusion in cold water, is an excel- 
lent bitter tonic where there is debility and loss of tone in the 
stomach. A hot decoction of quassia, well sweetened, acts as 



REMEDIAL AGENTS. 881 

a narcotic, and is very destructive to flies, and much safer than 
the ordinary fly-papers. 

Stomachic Tonic. 

Pare off the yellow rind of six large oranges, and cut them 
up fine, and put into a quart bottle, with one ounce of gentian 
root, and one of golden seal, crushed. Pour over these ingre- 
dients a pint of brandy ; shake the bottle well that and every 
day for seven days. Then let it settle for two days, and pour 
off carefully into another bottle for use. Take one or two tea- 
spoonfuls of it in a glass of wine, or in a cup of tea, before 
meals. This is an elegant preparation, and a most valuable 
tonic. 

Infusion of Columbo, or Collinsonia. 

Take columbo and collinsonia, of each a heaped teaspoonful ; 
boiling water, half a pint ; macerate on the stove for four hours, 
and strain. It is improved by the addition of two tablespoon- 
fuls of cinnamon, especially if it is for a case of diarrhoea. This 
is an excellent tonic, and will often allay the nausea and vomit- 
ing incidental to pregnancy. Dose, a small wineglassful three 
times a day, or more frequent. 

Cure for Ague, 

Take two ounces of Peruvian bark ; wild cherry bark, two 
ounces ; pulverized cinnamon and cloves, one ounce of each ; 
capsicum, one heaped teaspoonful ; sulphur, two ounces ; port 
wine, two quarts. Let it stand a few days. Purchase the Peru- 
vian bark solid ; and if you cannot pulverize it, see the druggist 
does it in your pressence, as it is an expensive article, and nearly 
all the powder in the market is adulterated. Dose, a wineglassful 
every two or three hours. It should be well shaken before using. 
It is an infallible cure for ague. It destroys the malarial germ in the 
blood. It need not be taken over twice a day when the chill is 
broken. 

Nitromuriatic Acid. 

Take two drachms dilute nitric acid, and add to it four ounces 
of water. A teaspoonful half an hour before meals in a little 
water. A good tonic when the liver is at fault. 

Aromatic Sulphuric Acid. 

Aromatic sulphuric acid, one ounce ; add to four ounces of 
syrup of orange-peel, and four ounces of water : mix. Dose, a 
tablespoonful in a glass of water before meals. A good tonic in 
dyspepsia. 

White Mustard Seed. 

This is one of the most valuable of all remedies in indiges- 

68 



882 REMEDIAL AGENTS. 

tion, debility, chronic inflammation of liver, torpid liver, slug- 
gish bowels, heartburn, pain in the pit of the stomach, cramp, 
loss of appetite, failure to sleep, weakness of the nerves, or 
nervous depression. Very useful in female derangements. It 
is of special utility in habitual drunkards whose stomach coats 
are destroyed by the whisky. The seeds should be taken whole, 
never crushed or bruised, in doses of from one to two teaspoonfuls one 
hour before meals in water, gruel, or mucilage. The dose to be 
regulated by the activity of the bowels, one or two motions per 
day. When the seeds reach the stomach and bowels, they exude 
a peculiar principle, which rouses into vital activity the secre- 
tions of the stomach, liver, pancreas. This exudation is wonder- 
fully tonic; the seeds give it out, and fail to be digested. Besides 
their special indication in the above diseases, they are also of 
great value in paralysis, ague, asthma, worms, all disorders of 
liver, and the infirmities of declining life. 

Cinchona Compound. 

Compound tincture of cinchona in teaspoonful doses in a little 
water, before meals. 7s a valuable tonic in all conditions of debility 
and want of appetite. 

Cinchona Compound and Aromatic Sulphuric Acid. 

Take four ounces of compound tincture of cinchona ; one 
ounce of aromatic sulphuric acid: mix. One teaspoonful in a 
glass of water before meals. Useful as a tonic in dyspepsia, gene- 
ral debility, ansemia, Brighfs disease, wherever a vitalizing remedy 
is indicated. 

Cinchona Compound and Nitromuriatic Acid. 

Take two ounces of compound tincture of cinchona; two 
ounces of simple syrup; two drachms of nitro-muriatic acid: 
mix. One teaspoonful half an hour before meals in a glass of 
water. Invaluable in all forms of dyspepsia; very efficacious in all 
forms of torpid liver, chronic inflammation, jaundice; in uterine 
hemorrhage, ansemia, debility. 

Cinchona Compound and Compound Tincture of Myrrh. 

Take four ounces of the compound tincture of cinchona; one 
ounce of the compound tincture of myrrh ; half an ounce of 
common salt: mix. One teaspoonful every three hours highly 
diluted with water. (Shake before pouring out.) Good as a 
tonic; uery stimulating, and will break up some mild cases of ague. 

Cinchona and Valerianate of Ammonia, 

Take two ounces of compound tincture of cinchona; two 
ounces of the ammoniated tincture of valerian : mix. Dose, a 
teaspoonful every three or four hours, highly diluted in water. 
In cases of great debility, prostration, nervous excitement, hysteria. 



REMEDIAL AGENTS. 883 

Peruvian Bark and Port Wine. 

Take one ounce of freshly pulverized Peruvian bark, and one 
pint of good old port wine. Mix them together, and allow the 
bark to steep in the wine. As soon as it is settled completely 
begin its use in from one to two or three tablespoonfuls before 
meals. A fine tonic; useful in general debility, and especially at the 
change of life. Its addition to the wine forms a tannate of cinchona, 
which renders it especially valuable to ladies. 

Peruvian Bark, Port Wine, and Acid, 

Take the same as the above, and add one ounce of aromatic 
sulphuric acid. Same dose as above. Particularly valuable when 
hsemorrhage takes place at the change of life. Give in ice-water. 

Quinine and Aromatic Sulphuric Acid. 

Take one ounce of aromatic sulphuric acid ; twenty or thirty 
grains of sulphate of quinine : mix. Dose, fifteen drops in a 
wineglassful of water half an hour before meals. Good as a 
general tonic ; but increase the dose of the quinine, and we have a 
valuable remedy for all fevers, especially the malarial. Splendid for 
night-sweats. 

Quinine, Aromatic Sulphuric Acid, and Syrup. 

Take four ounces of wild cherry syrup and add to it a drachm 
of aromatic sulphuric acid and thirty grains of sulphate of qui- 
nine. Dissolve the quinine in the aromatic sulphuric, and add 
to the syrup. The object in view being to disguise the bitter 
taste of the quinine. Some use syrup of roses, and others. 
Good tonic, efficacious in mild cases of ague among children. 

Cinchona, Phosphoric Acid, and Syrup. 

Take two ounces of compound tincture of cinchona ; three 
ounces of the syrup of orange peel; half an ounce, or a whole 
ounce of dilute phosphoric acid : mix. Dose, a teaspoonful 
after meals in a little water. In debility, with nervous shock. 

Other Tonics. 

Tincture of gentian, of columba, of collinsonia, are excellent 
bitter tonics in teaspoonful doses before meals. In debility, dys- 
pepsia, want of appetite. 

Golden Seal, or Hydrastis. 

Water is the best agent to extract its properties. Make a de- 
coction, say two heaped teaspootifuls to a half pint of water. 
Dose, one to two tablespoonfuls, half an hour before meals. 

The infusion keeps well if thirty drops of chloroform is added 
to the half pint. In dyspepsia, with sluggish liver. 

Hydrastis, or Golden Seal, Quassia, and Gentian. 

One ounce of hydrastics, one ounce of gentian, and two of 



884 REMEDIAL AGENTS. 

quassia chips : mix. Pour three quarters of a pint of boiling 
water on the whole, so as to give a half pint clear. Preserve 
by adding thirty drops of chloroform. Dose, one or two table- 
spoonfuls before meals. A good bitter tonic. 

Gentian and Nux Vomica. 

Take two ounces of the fluid extract of gentian ; two ounces 
of the fluid extract of golden seal ; and one ounce of the tinc- 
ture of nux vomica : mix. Dose, halt a teaspoonful added to a 
little water, half an hour before meals Excellent in all forms of 
indigestion and constipation ; also efficacious in piles. 

Columbo. 

Take one ounce of fluid extract of columbo ; the same quan- 
tity of dogwood ; the same of golden thread ; the same of stone 
root and bayberry : mix. Dose, from half to one teaspoonful 
before meals, in water. Very efficacious tonic in all forms of weak- 
ness of the bowels; of great utility in chronic diarrhoea. 

Lettuce. 

Take one ounce of the fluid extract of lettuce; the same 
quantity of lupuline ; the same of prickly ash and wild cherry : 
mix. Dose, one teaspoonful every four hours in water. Of great 
utility in nervous dyspepsia, especially if there is great restlessness 
and irritability. 

Fringe Tree. 

Take one ounce of fringe tree bark ; one ounce of dogwood : 
one ounce of elecampane ; two ounces of American columbo ; 
mix. Crush into a powder, and then add two quarts of sherry 
wine. Let it steep two weeks. Dose, a wineglassful half an 
hour before meals. Invaluable in dyspepsia, constipation, and 
chronic irritation of the liver* 

Agrimony. 

Take one ounce of the fluid extract of agrimony ; bitter root ; 
Solomon seal ; querbacho bark : mix Dose, from ten to thirty 
drops every four hours in warm water. Of great efficacy in 
dyspepsia, complicated with difficulty of breathing. 

Golden Seal. 

Take one pint of brandy ; one ounce of pulverized golden 
seal ; one ounce of phosphate of iron : mix. Shake well before 
taking. Dose, one to two tablespoonfuls before meals. Of great 
efficacy as a fertilizing blood tonic. Useful in anaemia. 

Life Root. 

Take four ounces of the fluid extract of life root ; one ounce 
of the tincture of nux vomica ; the same of damiana : and half 



REMEDIAL AGENTS. 885 

an ounce of tincture of cantharides : mix. Dose, one teaspoon- 
ful every two hours. Very useful in lethargy of the sexual organs. 

Bayberry, 

Take four ounces of the fluid extract of bayberry ; one ounce 
of fluid extract of cascarilla ; and one ounce of fluid extract of 
dogwood : mix. Dose, a teaspoonful every three hours in cin- 
namon-water. Very useful in diarrhcea and relaxation of the bowels. 

Kidney Tonic. 

Take one ounce each of the fluid extract of cleavers, queen of 
the meadow, coltsfoot, bucha, and uva *ursi : mix. Dose, one 
teaspoonful every three hours. Very efficacious as a tonic to the 
kidneys, catarrh of the bladder. Valuable as astringent, diuretic. 

Bowel Tonic, 

Take crude bayberry, pulverized, one ounce ; poplar bark, 
ditto; raspberry leaves, half an ounce: mix. Infuse in a pint 
of boiling water, and evaporate down to half a pint ; cool. A 
wineglassful every three hours. The efficacy of the above is 
greatly increased by the addition of cinnamon and capsicum 
to suit the taste. Of great utility as a drink in or after typhoid 
fever, where the bowels are weah 

Beef, Iron, and Coca, 

The express juice of raw beef, one ounce ; thirty grains of 
phosphate of iron ; and twenty to thirty drops of coca. Ery- 
throxylon coca in combination with beef and iron is extensively 
prescribed in convalescence from exhausting fevers, debility, 
overwork — both mental and physical — and in all cases where 
a strengthening and restorative remedy is required. In the 
treatment of impaired nutrition, impoverishment of the blood, 
and in all the various forms of general debility, its value is 
recognized by the practitioner. The above quantity for a dose 
every four hours. 

Beef and Acid. 

Beef chopped fine, half a pound ; a teacupful of water, acidu- 
lated with muriatic acid : mix together ; in five minutes strain 
off, and take at a dose. Repeat every three hours. Excellent in 
debility and anaemia. 

Vallet's Mass. 

Take one ounce of Vallet's mass ; mix thoroughly in it one 
drachm (sixty grains) of extract of nux vomica. Take a piece 
about the size of a pea or kidney bean, once, twice, or thrice 
daily. Very valuable in constipation from pure debility, chlorosis, etc. 



886 REMEDIAL AGENTS. 

CLIMATE FOR INVALIDS, 

It has been clearly demonstrated that sameness, monotony, 
isolation, confinement deteriorates and obliterates the cerebral 
convolutions of thought and reason, and reduces man to the 
level of an animal, whereas change of scene, air, surroundings, 
climate, diet and habits are most conducive to a higher state 
of mental and physical existence. The vitalizing effect of 
change is taken advantage of as a remedial agent, but though 
invaluable in itself, it should not be resorted to without due 
care, judgment and discretion, and a correct knowledge of all 
its bearings upon the precise status of health. It is not well 
for patients to migrate and simply find a grave, which is too 
often the case when the advice of an experienced physician is 
disregarded as to the selection of a proper place, or the ad- 
vanced nature of the disease. All chronic diseases, if the situ- 
ation is favorable are benefited, alleviated, or cured by a change 
of air, scene, climate, but especialty diseases of the brain, lungs, 
heart, digestion, gout and rheumatism, functional disorders of 
the sexual system. Diseases of the kidneys, which are so 
prevalent, are not only ameliorated but cured by change ot cli- 
mate. A change is of great utility in all blood diseases, espe- 
cially in tuberculosis, cancer, syphilis, skin, change of life, 
chronic disease, especially when tardy at recovery. Even hope- 
less, or what are termed incurable affections are benefitted by 
change, as it imparts mental exhilaration, increases vital force, 
promotes good digestion and sound sleep. 

There is no model climate for all diseases, no State or portion 
of State can boast of being perfect in its tellural, atmospheric 
and climatic condition. California presents a most remarka- 
ble exception to all our States, and to every country in the 
world in being the most salubrious, genial and bracing climate 
under the sun all the year round, and is a most benign cli- 
mate for all diseases, but withal Florida for six months every 
year surpasses it in its vivifying, vitalizing, curative properties 
in lung diseases. In both those States we possess an unchange- 
able, everlasting spring; an air to breathe rich in ozone; a 
climate never warm nor cold ; a celestial salubrity, with every 
fruit and vegetable in the known world perpetually in season. 

Consumption of the lungs is the most prevalent and fatal of 
all diseases in our country, and for this both California and 
Florida offer an unexcelled climate; the former is dry, the latter 
moist. The location to be selected that has the best advantages, 
is the lower portion of California and the upper portion of Florida, 
embracing a point from Jacksonville to the extreme southern 
boundary of Orange and Sumpter counties. The aspect, drain- 
age, elevation above the sea level, the temperature, equability, 
dryness and moistures, luxuriant vegetation and entire absence 



REMEDIAL AGENTS. 887 

from decaying vegetable matter, render this the chosen spot of 
all others on the American continent for sufferers with laryn- 
gitis, bronchitis, asthma, emphysema, and consumption of the 
lungs ; perhaps the only spot in the known world where the 
latter disease is perfectly arrested. The beneficial effects of the 
climate of California, and that portion of Florida mentioned, 
are due to a variety of causes, as the extreme purity of the 
atmosphere, the evenness or sameness of temperature. This is 
chiefly caused by the sea air being constantly wafted over the 
peninsula, and to the presence of an even amount of ozone in 
it. This same condition is further enhanced by the species of 
vegetation, which is chiefly of an ozone-yielding kindf Ozone 
is the important constituent of the atmosphere of those States. 
This allotropic condition of oxygen possesses great power in 
the destruction of all disease-germs in the air. Florida un- 
doubtedly derives much of it from the sea breezes wafted over 
it ; California, from her mountains, her flora, her trees. But 
there is no location in either State but what is freely supplied 
with this vitalizing agent; there it exists in the air of marshes, 
in aquatic plants ; the balsamic odors of trees and flowers con- 
vert the oxygen of the air into ozone. It is not necessary to 
hunt up the balsamic odors of pines, when every tree yields it 
in perfection. The atmosphere of Colorado is very rarified, and 
well adapted for diseases of the heart, asthma, and emphysema, 
but its ozone is very variable at certain seasons and in different 
localities. The ozone is the great scavenger of nature, and of 
diseased or impure blood ; a stimulant to the vital functions 
of the body, a true vitalizing agent. Its own properties are of 
intrinsic value, but its combination with the aroma of trees and 
plants of an ozone-yielding faculty, render the air very invigor- 
ating. In California, there is, in addition to the sea-air ozone, 
that derived from mountains, which is freely liberated ; besides, 
the atmosphere from the mountain tops is very pure, and may 
be greatly rarified, but still from its constant changes contains 
an unlimited amount of the purest ozone. In addition to this 
excess of ozone in the climate of Florida, its atmosphere being 
renewed daily from the sea, contains iodine and bromine in 
great abundance, enough to destroy all the diseased germs of 
tubercle, cancer, and syphilis in the whole world. Besides, its 
moisture tends to diminish positive oxygen, which is so inju- 
rious to weak lungs, and which is one of the most prevalent 
causes of tuberculosis in the Eastern States. On the elevations 
of Orange and Sumpter counties there is a considerable diminu- 
tion of atmospheric pressure, and the air, very tonic and bracing, 
promotes an appetite, aids in the elaboration of good, pure blood. 
In the United States we have every variety of climate to select 
from, so as to suit the nature of the disease : 



888 REMEDIAL AGENTS. 

A Braciny Climate. — We have it in Florida and California. 
In the former, during the six winter months ; in the latter, 
during the entire year, with air full of ozone, well suited to 
pulmonary consumption. 

An exciting climate is to be found in the New England States, 
Michigan, Minnesota ; a highly electric state of the atmosphere, 
abundance of ozone, but very cold in winter. 

A sedative atmosphere is to be found in North Carolina, Geo- 
gia, Alabama ; a relaxing climate in Louisiana, Texas, Mexico. 
The death-rate of native born residents of the different States 
and localities cannot be very accurately ascertained, but the 
following is an approximate table of the deaths of native to 
the one thousand : 

In California and Florida, . . the death-rate is 16 to 1000. 
" Oregon and Washington Ter., " " 20 

" Georgia and North Carolina, " " 20 

" St. Paul's, Minnesota, " " 24 

" New England, " " 27 

" Michigan, Canada, Ohio, " " 33 

" Baltimore, Md., and Virginia, " " 38 

" New York, " " 40 

" Philadelphia, Pa., " " 49 

The air of the New England States in summer is very bracing 
and tonic; the atmosphere is pure, the soil dry, water good. 
All diseases of the nervous system are much benefited by its 
invigorating action, especially if the vital powers are sluggish. 
The air in winter is biting cold, neither genial nor mild, but 
yet salubrious, and is favorable for longevity, as well as for the 
develepment of the mental and physical powers. In some of 
the older towns where the stock is pure, the longevity is remark- 
able, persons from eighty to ninety being seen in the streets in 
full possession of all their faculties. The mental culture is very 
high and diffused, the brain calibre great. 

Long Island, Long Branch, Atlantic City, Cape May, are more 
suitable for summer visitors requiring change of air and occu- 
pation, than for invalids who need quietness and repose, in 
addition to a bracing atmosphere. The air is tonic and invigor- 
ating; the winter climate more equable and agreeable. 

New York, Pennsylvania, Delaware, Virginia, are bad for con- 
sumption, the atmosphere being subjected to sudden vicisi- 
tudes of change. It is very destructive in catarrhal, bronchial, 
lung, and pleuritic affections, besides being prolific in cancer, 
cutaneous, and diseases of the generative organs. 



INDEX. 



PAGE 

Abdomen, Contusion of, 428 

Abortion, 715 

Missed, 715 

Abscess of the Antrum, 681 

Brain, 194 

Breast 587 

Iliac, 677 

in Joints, 690 

of Labia, 503 

Lumbar, 677 

Psoas, 677 

Retro-Pharyngeal, 338 

of Testicle 483 

of the Walls of the Abdomen, . . . 429 

Acetate of Ammonia, 796 

Acetic Syrup of Bloodroot, 819 

Tincture of Iron, 831,871 

Aching Kidney, 721 

Acholia 161 

Acids, 762 

Acid. Aromatic Sulphuric, . . . 881, 885 

Benzoic, 786 

Bromohvdric, 794 

Carbolic, 864 

Chromic, 817 

Citric, 797 

Diathesis 451 

Gallic, 807 

Nitric, 807 

Nitromuriatic, 810, 892 

Oxalic, Diathesis, 454 

Phosphoric, 880 

Sulphuric 807 

Sulphurous 802 

Acne, 644 

Aconite 803 

Belladonna, and Veratrum, ... 804 

and Sweet Spirits of Nitre, .... 803 

and Veratrum, 804 

Aero-Narcotic Poison, 769 

Acupuncturation, 784 

Acute Atrophy of the Liver, 401 

Desquamative Nephritis 440 

Catarrh, 284 

Corneitis 609 

Inflammation of the Brain, . . . 186 

Bladder, 460 

Kidnevs 439 

Liver 393 

Ovarv, 543 

Prostate Gland 476 

Stomach 342 

Vagina, 507 

Laryngitis, 290 

Meningitis 186 

Peritonitis, 421 

Phthisis Pulmonalis, 321 

Synovitis, 689 

Testitis 481 

Tonsillitis 334 

Adenoma, 153, 437 

After-Pains 714 

Agalactia, 590 

Agents, Remedial, 773 

Ague, 83 



PAGE 

Ague Cure, 881 

Albumen in Urine, 62 

Albuminuria in Pregnancy, ..... 702 

Alcohol 767 

Alcoholic Coma, 184 

Habit, 252 

Vapor Bath, 812 

Alimentation, 776 

Alkalies, their Salts, 763 

Alkaline Bath, 810 

Poultice, 866 

Aloes and Sabina 832 

Alterations in Color, 55 

Alteratives, 785 

Alterative Pills, 787 

for Rheumatism, 787 

Syrup 787 

Alum, 868 

Coagulum, 847 

and Sulphuric Acid 807 

Amaurosis, 615 

Amblyopia, 600 

Amenorrhcea, 512 

American Valerian, 797 

Ammonia 820,822,824 

Muriate, Wash of, 846 

Amyloid Degeneration 178 

of Kidney, 446 

of Liver 399 

Amyl, Nitrite, 794 

Ansemia, 148 

of Brain. Spinal Cord, 229 

Aneesthesia, Local, 792 

Anaesthetics 788 

New Method of Administering, . . 790 

Purity of, 790 

Anaphrodisiacs, 798 

Anchylosis 692 

Androphomonomania, 213 

Aneurism, 277 

Abdominal Aorta, 278 

Cardiac, 277 

Thoracic Aorta, 277 

Angina Pectoris 266 

Anodynes, 793 

Antacids, 795 

Anterior Curvature 680 

Ante version, 541 

Anthrax 113,655 

Anti-Rheumatic Alterative, 786 

Antiseptics, 799 

Antiseptic Poultice, 867 

Treatment 801 

Antispasmodic 797 

Antrum. Abscess of, 681 

Dropsy of, 681 

Tumors of, 681 

Anus, Imperforate, 737 

Aortitis, 274 

Aphasia, 197 

Aphonia 294 

Aphrodisiac, 798 

Aphtha; 331,743 

Infantile 831 

Mercurial, 332 



890 



INDEX, 



PAGE 

Aphthae, Syphilitic 332 

Tubercular, 332 

Appetite, 54 

depraved, 700 

Apoplectic Coma 185 

Apoplexy, 198 

of Lung 319 

Arcus Senilis, 610 

Aromatic Syrup of Blackberry, .... 808 

Arrowroot, 778 

Arsenic, 255, 764 

Arterial Sedatives 803,805 

Arthritis, 171 

Artificial Respiration, 759 

Ascites, 427 

Asclepias, Infusion, 822 

Asphyxia, 724,757 

Asthma 298, 821 

Rosin Weed, 820 

Asthenopia, 598 

Astigmatism, 598 

Astringents, 806, 808 

Astringent Enema 833 

Ataxia, Locomotor, 242 

Atrophy of Bone, 675 

of the Heart 256 

of the Liver, 401 

Muscular, 669 

of Testicle 485 

Progressive Muscular 245 

Atropia, Hypodermically, 837 

Solution, 846 

Attitude, 730 

Auditory Vertigo, 626 

Auscultation 48 

Autophomonomania 213 

Balanitis, 143,468 

Baldness, 653 

Balm of Gilead, 848 

Tea, 822 

Balsam Copaiba, 828 

ofHoarhound, 821 

Barley-water, 779 

Basilicon Ointment, 844 

Baths 878,832,810 

Acid, ." 814 

Alcoholic Vapor, 812 

Alkaline, 810 

Borax, 811 

Bran 810 

Conium and Starch, 811 

Gelatine, 812 

Iodine 814,811 

Mustard Foot 813 

Nitromuriatic 810 

Refreshing 814 

Russian, 813 

Saltwater, 811 

Shallow 814 

Shower (Cold Effusion), 813 

Sulphur, 811 

Temperature of, 810 

Turkish, 813 

Bayberry 806, 808 

Bay Rum *. . . 848 

Beef Extract, 776 

Tea 776-777 

Instantaneous, 777 

Belladonna, 799 

and Aconite, 804 

Ointment and Todide Potassa, . . 840 

and Opium, 872 

Belly Wounds, 667 

Benzine for Itch 849 

Benzoic Acid, 786 

Betin 831 

Pill, 857 

Bicarbonate Potassa, 795 

Drink 795 



PAGE 

Bile in Urine, 63 

Biliary Diarrhoea, 359 

Bilious Colic, 364 

Fever, Remittent 91 

Malignant, 91 

Simple 82 

Headache, 183 

Temperament, 67 

Bismuth, 764 

Colic, 365 

Bites, 825 

of Animals and Reptiles, .... 175 

Blackberry Cordial 809 

Leg, 155 

Salve, 843 

Stools, 360 

Wash 848 

Bladder, Acute Inflammation of, . . . 460 

Chronic Inflammation of, ... . 461 

Irritability of, 465 

Paralysis of, 466 

Spasms of, 466 

of Sphincter, 463 

Tumors of, 467 

Bleeding from Nose, 289 

Blindness, 615 

Bloodmaker and Purifier, 787 

Bloodroot, Syrup of, 819 

Bloody Tumors of Labia, 717 

Blue Cohosh 832 

Skin 273 

Body, Weight of, . 61 

Bone, Atrophy of, 675 

Hypertrophy of, 675 

Boiled Flour, 778 

Boils 650 

Borax Bath, 811 

Lotion, 845 

Ointment 841 

and Sabina, 831 

Brain, Abscess of, 194 

Acute Inflammation of, 186 

Atrophy of, 210 

Chronic Inflammation, 192 

Cerebellum, Softening of, .... 195 

Concussion of, 200 

Dropsy of, 195-197 

Haemorrhage in, 201 

Hypertrophy, 201 

Inflammation of its Membranes, . 189 

Induration of, 194 

Its Diseases 186 

Shrinkage of, 202 

Softening, Red 194 

White 194 

Tubercular Inflammation of, . . . 190 

Tumors and Deposits 195 

Bran Bath, 810 

Poultice, 865 

Brandy 824 

and Egg Mixture, 779 

and Iron 880 

Brass Founders' Disease, 181 

Bread and Milk Poultice, ' 866 

Breast, Abscess of, 587 

Cancer of, 595 

Hypertrophy of, 592 

Inflammation of, 586 

Tumors of, 593 

Breasts, Milk in, 733 

Breath 731 

Breathing, Difficult, 302 

Snoring, 303 

Stertorous, 303 

Bright's Disease, 441 

Bromide of Ammonia 872 

of Potassa, 872 

and Gelseminum, 799 

Bromohydric Acid, 794-820 

Bronchitis 304,821 

Acute, 305 



INDEX. 



891 



PAGE 

Bronchitis, Chronic, 306 

Hay, 310 

Infantile, 309 

Mechanical, 310 

Plastic, 309 

Secondary, 310 

Senilis 308 

Bronchocele, 157 

Bubo, 475 j 

Buccal Glands 334 

Buchu, 827 i 

Bullae 635 

Bunion, 658-844 '< 

Burns 648-844-845 ! 

and Scalds, 754 

Bursa; 671 



Cajeput and Cloves, 825 

Calabar Bean, 872 

Calcareous Degeneration 179 

Deposits in Liver, 403 

Calculi, 457 

in Bladder 458 

in Kidney, 458 

in Ureter, 458 

Camphor 802 

Camphor-water 847 

Camphorated Oil, or Lard, 843 

Cancer, Epithelial, 135 

Hsematoid 135 

Medullary 135 

Melanotic, 135 

Seirrhus, 135 

Villous, Lardaceous, Osteoid, Keloid, 135 

Cancer, 818 

a Sequel of Abortion, 717 

of the Breast, 595 

Duodenum, 355 

Eye 619 

Heart 274 

Kidney, 448 

Liver, 404 

Lung 320-327 

(Esophagus, 341 

Penis 481 

Rectum, 389 

Stomach 345 

Tongue 330 

Tonsil, 336 

Uterus, 537 

Vulva, 504 

Caoutchouc Solution, 863 

Capsicum 797, 824, 863, 873 

Carbolic Acid 864 

Carbonate of Soda, 797 

Carbuncles, 650 

Carcinoma, 135 

Carditis, 261 

Care and Culture of the Infant, . . . 750 

Caries of Bone, 674 

of the Teeth, 330 

Carrot Poultice, 867 

Cartilaginous Tumors, 663 

Cascara Sagrado, 857 

Castor Oil, 871 

Catalepsv, 210, 775 

Cataract 613 

Catarrh, Acute, 824 

of the Bladder, 461 

Chronic, 285 

Gastric, . . 351 

of Children, 353 

Intra-uterine, 861 

Catarrhal Ophthalmia 60S 

Catechu and Chalk Mixture, .... 807 

Caucasian, The, a Distinct Race, ... 20 

Causes of Death, 771 

Caustics 817 

Caustic Potassa 763 

Cavernous Tumor in Liver, 403 



PAGE 

Cephala?matoma, 736 

Cerebral Inflammation, 185 

Cerebro-spmal Meningitis, 110 

Chafing, 736 

Chancre, . . . . • 143 

Change of Life, 550 

Chapped Hands 659 

Character of Stools, 58 

of Urine, 62 

Charcoal Poultice, 867 

Chest Wounds 666 

Chicken Extract, . . . : 777 

Chilblain, 649 

and Bruises, 843 

Childbirth, 695 

Chloral Habit, 254 

Hvdrate, 793 

Ointment, 841 

Chlorate Potassa 786, 796, 802 

Gargle, .835 

Lotion 846 

Chlorides in Urine, 63 

Chloride of Chromium, 818 

Ozonized, 853 

of Lime, 801-803 

of Zinc, 801-817 

Chlorinate Soda Gargle, 836 

Chlorinated Soda, 801 

Chlorine, 801 

Chlorodvne, 793 

Chloroform 823, 788 

Chlorosis, 153 

Cholera, 376 

Epidemic, 380 

Infantum 377 

Mixture, 809 

Morbus, 379 

Chordee, 142 

Chorea, 228, 701 

Chromic Acid 817 

Chromium, 818 

Chronic Alcoholism 202 

Atrophy of Liver, 402 

Catarrh, 285 

Desquamative Nephritis 441 

Diarrhoea, 360 

Gout and Rheumatism in Joints, . 690 

Inflammation of Bladder, .... 461 

of Brain, 192 

of Liver 395 

ofOvarv 544 

of Prostate Gland 477 

of Spinal Cord, .' 223 

of Stomach, 343 

of Vagina, 508 

Larvngitis, 291 

Phthisis, 322 

Peritonitis, 422 

Rheumatism, 166 

Synovitis 690 

Tonsillitis, 335 

Ulcer, 653 

Chrysophanic Acid Ointment 841 

Chvluria 450 

Cider and Nitre, 827 

Cinchona, 880-882 

and Aromatic Sulphuric Acid, . . 882 

and Myrrh, 882 

and Nitromuriatic Acid, 882 

and Nux Vomica, 798 

and Phosphoric Acid, 883 

and Valerian 882 

Circocele 486 

Circulation 732 

Citric Acid 797 

and Carbonate of Soda, .... 797 

Clap 142 

Classification of Fevers 80 

Clavicle, Fracture of, 686 

Clay, Ozonized .855 

Cleavers 828 



892 



INDEX. 



PAGE 

Cleft Palate, 744 

Clericorum, 293 

Clitoris, Diseases of, 505 

Closure, Nasal, 617 

Club Foot, 745 

Clysmic Water, 797 

Coagulum of Alum, 847 

Coccyodynia, 721 

Coccyx, Fracture, 688 

Coffee 252 

for Chills, 803 

Cohosh, Blue 832 

Colchicum, 786 

and Chlorate Potassa, 796 

Cold, 761 

and Heat 88 

and Hot Lotion 846 

Lotion, 846 

Colic, 364 

Bilious, 364 

Bismuth, 365 

Copper, 365 

Flatulent, 364 

Lead, 365 

Nervous, 365 

Tin 365 

Collapse, 69,754 

of Lung, 319 

Colloid Tumors, 663 

Styptic, 864 

Collodion Paints, 863 

Color Blindness 598 

Columbo and Collinsonia, 881 

Coma 755 

Alcoholic, 184 

Apoplectic, 185 

Epileptic 183 

Opium, 185 

Uraemic, 185 

Varieties, 765 

Common Bath, 811 

Ophthalmia, 604 

Composition, 825 

Compound Fracture, 685 

Conception, 695 

Concretions, 363 

Concussion of the Brain 200 

Congestive Headache, 183 

Conical Cornea, 610 

Constipation, 360 

Continence of Urine, 462 

Continued Fever, 80 

Contusion, 752 

of Abdominal Walls, 428 

Convulsions 211 

During Pregnancy 701 

Infantile, 212 

of Infancy, 737 

Puerperal, 212 

Cordial, Blackberry, 809 

Cornea, Albugo 610 

Leucoma, 610 

Nebula, 610 

Opacities of, 610 

Ulcers of, 610 

Corneitis 609 

Corns, 658, 865 

Plaster, 864 

Solvent 863 

Corpulency, 417 

Corroding Ulcer of Vulva, 504 

Cotton Root, 832 

Couch Grass, 828 

Cough 303 

Mixture, 821,822 

Remedies, 818 

Countenance, 727 

Coup de Soleil, 204 

Crabs, 660 

Cracked Tongue 329 

Cramp, 671 



PAGE 

Cramp Colic, 826 

Cranberry Poultice, 867 

Cranesbill, 806 

Cream of Tartar Drink, 795 

Cretinism, 158 

Croaking Voice, 330 

Croton Chloral ; 794 

Oil Liniment, 863 

Croup, 295 

Cry 731 

Cubebs 828 

and Cream of Tartar, 827 

Cure for Ague, 881 

Cramps, 798 

Felon, 865 

Curvature, Anterior, 680 

Lateral, 678 

Posterior, 679 

Spinal, 678 

Cyanosis, . . . 273 

Cystic Degeneration of Kidney, ... 447 

Tumors, 663 

in Liver, 403 

Cysts of the Uterus, 536 

Damiana Compound 798 

Dandruff, 644 

Deafness, 628 

Death Causes, 771 

Deformities, 705, 743 

Degeneration, Amyloid, 178 

Calcareous, 179 

Fatty 178 

of Kidneys, - . . . . 445 

of Liver, 399 

Delirium Tremens, 202 

Dementia, 214 

Demulcent Drink, 780 

Dengue, 105 

Dentition, Difficult, 741 

Determination of Sexes, 22 

Deterioration of Race, 37 

Depraved Appetite, 700 

Derangement of the Heart, 265 

Development of the Foetus, 698 

Diagnosis, 43, 66, 729 

Diaphoretics, 822 

Diarrhoea 348, 809 

Biliary 359 

Chronic 360 

Feculent, 359 

Melaena, 360 

Muco-Purulent, 36 

Diabetes Mellitus, 409 

Diastase, 780 

Diaphragmatic Hernia, 435 

Diastolic Sound, 50 

Diet, 235 

Difficulty of Breathing, 302 

Digitalis, Aconite, 799 

Dilatation of the Heart, 260 

Stomach, 344 

Diminished Secretions, Milk 590 

Diphtheric Paralysis, 107, 246 

Diplopia, 600 

Dipsomania, 215 

Dissection Wounds, 177 

Disease Germs, 34, 69 

Diseases of the Antrum, 681 

Breast 586 

Bones, 672 

Clitoris 505 

Cornea, 609 

Duodenum, 355 

Ear, 619 

Eustachian Tube 625 

Eyelids, 601 

Iris 610 

Infants, 733 

Joints, 689 



INDEX. 



893 



PAGE 

Diseases of the Muscles, Tendons, and 

Bones, 668 

Nipple, 588 

Pancreas, 412 

Spleen, 418 

Suprarenal Capsules 459 

Vessels of Liver, 898 

Displacement of the Uterus, 538 

Ovaries, 547 

Dislocation 693 

of the Clavicle, 694 

Elbow 694 

Hip-joint 694 

Knee and Foot, 694 

Lower Jaw, 693 

Shoulder Joint, 694 

Wrist and Fingers, 694 

Diffusible Stimulants, 824 

Digitalis, 827 

Disinfectants 799 

Disinfectant for Body Linen, .... 800 

Disperse Swelling, 842 

Disseminated Sclerosis of Cord, ... 244 

Diuretics, 826 

Diuresis 449 

Dog-Bite 754 

Dover's Powders 822 

Dracontiasis 375 

Dropsvof the Abdomen 427 

" Brain, 195 

Cellular Tissue, 427 

Chest 274,426 

Fallopian Tube, 548 

Head, 426 

Heart, 426 

Kidnev, 447 

Scrotum, 486 

Dropsy 423, 426 

in Pregnancy, 702 

Drowning, 758 

Drunk, 780 

Dry Murmurs, 49 

Dyspepsia, 347 

Boulimic, 347 

Wind, 347 

Duodenal 3-5 

Dysentery, 383 

Ear, 619 

Ear-Ache, 627 

Eating Ulcer, 655, 666 

Ear. Foreign Bodies in, 753 

Earths and their Compounds 763 

Ectropion 602 

Eczema 634 

Ecthyma, 636 

EeehVmosis, 752 

Effect of Fashion 37 

of Inflammation 76 

Effusion of Serum, 76 

ofBlood, 77 

of Lymph, 77 

Egg Mixture, 779 

Elateria 871 

Electricity 65, 235, S15 

Elongation of the Uvula 337 

Elephantiasis, 647 

of Scrotum, 488 

Elbow- Joint Fracture, 687 

Elder-Flower Water, 847 

Elm Poultice, 866 

Emaciation, 56 

Embolism 158 

Emphysema, 301 

Vehicular, 301 

Interlobular 301 

Emmetropia 597 

Emergencies 751 

Emetics 829 

Emmenagogue, 831 



PAGE 

Endocarditis, 261 

Enteritis, 356 

Entozoa, 366 

Encysted Tumor of the Vulva 502 

Endometritis, 529 

Entropion, -.602 

Enemata, 833 

Enema, Simple 833 

Astringent, 833 

Narcotic, 833 

Turpentine, 833 

Enemas, Various, 833 

Ephemeral Fever, 80 

Epidemic Fever, 110 

Cholera 380 

Epizooty, 175 

Epileptic Coma, 185 

Epilepsy 205 

Infantile 209 

Epistaxis, 289 

Epispadia, 474 

Epiphora, 603,617 

Epsom Salts, 870 

Erysipelas, 106 

Erotomania, 214, 216 

Ervthema, 631 

* Pudendal 501 

Ergotine, 874 

Ether 788 

Eustachian Tube, 625 

Eucalyptus, 856 

Expression, 58 

Exhalation from Tonsil 336 

Exanthemata 630 

Exostosis, 675 

Excoriations 736 

on Pudendi, 703 

Extracts of Beef, 776 

of Chicken, 777 

of Malt, 781 

Expectorants, 818 

Eyes, Foreign Bodies in, 754 

False Joint 684 

Falling of the Womb, 861 

Fashion, Effects of, 37 

Fattv Defeneration, 178 

of Liver 400, 445 

Heart, 257,258 

Tumor of Breast, 593,662 

Fever, 70 

Simple, 80 

Gastric, 81 

Bilious, Simple, 82 

Malarial, 83 

Remittent Bilious, 91 

Malignant, 91 

Relapsing, 91 

Tvphoid 92 

Typhus 99 

Yellow 102 

Breakbone 105 

Spotted, 110 

Puerperal, Ill 

Anthrax, 115 

Surgical, 116 

Eruptive 118 

Scarlet, 120 

Milk 720 

Miliary 720 

Feculent Diarrhoea, 3"9 

Femoral Hernia, 434 

Femur Fracture, (V S 

Felon Cure, 865 

Fibroid Lung, 319 

Uterus, 539 

Tumors of Breast, 394 

Tumors, 662 

Filaria Sanguinosis Hominis 375 

Fibrous Tumor, Vagina 503 



894 



INDEX. 



PAGE 

Fibrous Tumor, Breast, 594 

Fistula in Ano, 391 

in Urethra 473 

Vesico-Vaginal, 718 

Recto- Vaginal, 719 

Fistulous Ulcer, 473 

Fits— Nine-day, 737 

Flatulence, 364 

Flatulent Colic, 364 

Flat-foot, 746 

Formation of Pus, 78 

Foetid Breath 336 

Follicular Inflammation of the Vulva, . 500 

Stomatitis, 333 

Foot Diseases, 657 

Fore-arm Fracture, 687 

Forcing Powders in Labor 714 

Foeticide, 716 

Foreign Bodies in Air Passages, ... 753 

in Eyes, 754 

in Ear, 753 

in Nose, 753 

Food, Solid 780 

Fomentations 834 

Friction Sound, 49 

Frambcesia, 647 

Fracture of Bone, 682 

of Clavicle, 684 

ofCoccvx 688 

of Elbow- Joint, . . 687 

of Femur, 688 

of Fore-arm, 687 

of Humerus, 686 

of Lower Jaw, 684 

of Leg and Foot, 689 

of Nose and Upper Jaw, 684 

of Pelvis, 688 

of Patella, 688 

of Ribs 687 

of the Skull, 685, 686 

of Scapula, 684 

Freckles, 848 

Frostbite, 649 

Fungus of the Testicle, 485 

Functional Aphonia 294 

Derangement of Heart, 265 

Fucus Vesiculosus, 795 

Gait, 57 

Galactorrhcea 592 

Gallic Acid, 807 

Gall Bladder, Inflammation of, ... 398 

Duct 398 

Stones 405 

Ganglion 671 

Gangrene, 79 

Gangrenous Stomatitis 333 

Vulvitis 500 

Gargles, 834 

Gargle of Alum and Myrrh, 836 

of Borax, 835 

of Borax and Wild Indigo, .... 835 

of Chlorate Potassa, 835 

of Chlorinated Soda 836 

of Golden Seal 835 

of Muriatic Acid, 834 

of Permanganate Potassa 836 

of Sage Tea and Honey, .... 835-837 

Soothing, 838 

of Sulphate of Soda, 836 

of Sulphur, 835 

of Tannic Acid 835 

of Tannic Acid and Chloride Potassa, 836 

of Tincture Iodine 836 

of Vinegar and Salt, 834 

Gases, 763 

Gastralgia, 351 

Gastric Catarrh, 351 

Fever, 81 



PAGE 

Gastric Ulcer, 345 

Gastrodynia 350 

Gelatine Baths, 812 

Gelseminum 799-805 

Gelsemin and Veratrum, 805 

Gem Tooth Wash, 868 

General Symptoms of Pregnancy, . . . 701 

Gesture 730 

Giant Bacteria, 113 

Glanders, 174 

Glands, Buccal, 334 

Glandular Tumors 663 

Tumors of Breast, 594 

Glauber Salts, 870 

Glaucohaemia, 160 

Glaucoma, 614 

Gleet, . .' 143-147 

Glossitis, 328 

Glycerite of Kephaline 880 

of Kephaline, Ozonized, 852 

of Ozone, 851 , 880 

Goitre 157 

Gold, 765 

Golden Seal, . 883 

Tincture, 828 

Gonorrhoea, 142 

Gonorrhceal Ophthalmia, 606 

Gout, 168 

of the Ear, .629 

in Joints 629 

Gouty Keratitis, 609 

Granular Growths of Ear, 624 

Ophthalmia, 607 

Gravel, Mulberry, 454 

Red, 451 

Red and White, in Children, . . . 455 

White, 457 

Graves's Disease, 153 

Great Sympathetic, Anaemia of, ... 229 

Gruel, 779 

Guarana, 794 

Gum Guaiacum, 787 

Habits 252 

Alcohol, 252 

Arsenic, 255 

Chloral 254 

Opium, 254 

Tea and Coffee, 252 

Tobacco 253 

Hsematocele, 487-503-548-717 

Hsematuria, 450 

Hsematozoa 171 

Hemorrhage, 667 

Hemorrhage in Brain, 201 

after Delivery, 751 

before Delivery 751 

from Bowels, 751 

Ear 624 

Kidneys, 751 

Lungs, 751 

Nose, 751 

Stomach, 751-341 

Uterus 751-753 

Spinal 225 

Uterine, 534 

Hemorrhagic, 633 

Diathesis, 178 

Haemorrhoids, 390 

Haircap Moss, 828 

Hair-Dye, 849 

Harelip, 744 

Headache, 183 

Bilious 183 

Congestive, 183 

Nervous, 183 

Organic, 183 

Health 42 

Healthy Ulcers, 652 



INDEX. 



895 



PAGE 

Heart, Aneurism of, 277 

Atrophy of, 356 

Cancer of, 274 

Dilatation of, . 260 

Dropsy of, 264-265 

Fatty Degeneration of, ... 257-258 

^ Functional Derangement of, . . . 265 

Hypertrophy of, 257 

Inflammation of, 261 

Neuralgia of, 266 

Rupture of, 273 

Valvular Disease, 269 

Heartburn, 351 

Heat and Cold 808 

Hemeralopia, 600 

Hemicrania 249 

Hemiopia 600 

Hemiplegia, 238 

of Penis 474 

Hernia, 429 

Crural 434 

Diaphragmatic, 435 

Femoral, 4:34 

Inguinal, 433 

Irreducible, 431 

Ischiatic, 425 

Labial, 435 

Obturator, 435 

Perineal, 435 

Pudendal 435 

Reducible, 430 

Strangulated, 431 

Umbilical, 435 

Vaginal, 435 

Ventral, 435 

Herpes, 635 

Prceputialis, 471 

Hiccough, 738 

Hide-bound, . 738 

Hindoo Bitter, 834 

Hip Disease, 695 

Home-Sickness, 218 

Hooping Cough 266 

Hospital Gangrene, 651 

Hot Drops, 825 

Hour-Glass Contraction of Uterus, . . 711 

How to Breathe, 39 

How to Guard against Disease, .... 41 

How to Recognize Disease, 43 

Humerus, Fractures of, 686 

Hunterian Chancre, 144 

Hydatid Cysts 594 

Tumor in Liver, 403 

Hydatids in Kidney, 449 

Hydrastis, . . . . 883 

Hydrocele, 486 

of the Cord, 487 

Hydrocephaloid Disease, 195 

Hydrocephalus, 195 

Hydronephrosis, 447 

Hydrophobia, 172 

Hydrops Pericardii 264 

Hydrothorax, 274 

Hyoscyamus, 793 

Hypermetropia, 599 

Hypertrophy of Bone 675 

of the Breast, 592 

of the Heart 257 

of Labia, 503 

of Liver, 402 

of Muscles 670 

of Testicle, 485 

of Tongue 329 

Hypodermic Medication, 837 

Hypospadias, 474 

Hysteria, 531,850 

Hysterical Paralysis 245 

Ichorrhpemia 162 

Iceland Moss 780, 820 



PAGE 

Ichthyosis 644 

Idiocy, 214 

Imperforate Anus, 737 

Impetigo, 637 

Impotence of Man 495 

of Woman, 497 

Incontinence of Urine ". 462 

Induration of Brain, 194 

of Pylorus, 344 

Indigestion, 347 

Indolent Ulcer, 653 

Indian Turnip Ointment, 844 

Poultice 868 

Inflamed Ulcer, 652 

Inflammation, 74 

Bone, 673 

Bowels 356 

Breast, 586 

Brain 186 

Bursse 671 

Caecum, 657 

Covering of Heart 263 

Cellular Tissue of Pelvis, . . 549, 660 

Choroid, 612 

Duodenum, 355 

External Meatus, 620 

Gall-Ducts, 398 

Heart, 261 

Liver, . 393 

Lungs 310 

Lymphatic 437 

M'atrix of Nail 656 

Membrana Tympani, 620 

Mouth, 333 

Navel, 733 

Parotid, 337 

Prostate Gland, Acute, 476 

Rectum 385 

Spinal Cord 223 

Stomach 342 

Tendons, 671 

Testicles, 481 

Urethra, 471 

Vagina, 718 

Veins, 279 

Vulva, 500 

Womb, 520 

Infantile Aphtha? 331 

Cholera, 377 

Convulsions, 212, 737 

Epilepsy, 209 

Leucorrhcea, 501 

Mortality, 728 

Nutrition 746 

Ophthalmia, 603 

Paralvsis 244 

Syphilis, 739 

Infant at Birth, 725 

Care and Culture 750 

Diseases, 728-729 

Peculiarities, 728 

Infecting Chancre 143 

Non-Infecting Chancre, 143 

Inflamed Ulcer, 652 

Influenza, 228 

Infusions 826 

of Asclepias 822 

Infusion of Lobelia 847 

ofCubebs, 881 

Ingrowing Toe-Nail, 656 

Inorganic Poisons 767 

Inguinal Hernia, 433 

Inhalations, 838> 

Injuries 664 

j Injections, 845 

Iliac Abscess, 677." 

Iodine 764,786,-818. 

Bath 811-814 

Gargle, 836 

Insects' Bites, 825 

I Venomous, 772 



896 



INDEX, 



PAGE 

Intoxication, 826 

Inunction, 839 

Invigorator, 857 

Insensibility, 755 

Insanity, 212 

with Paralysis, 214 

Epilepsy, 215 

Inspection, 43 

Intermittent Fever 83 

Intense Cold, 761 

Inter-Lobular Emphysema, 301 

Intestinal Ascarides, 370 

Concretions 363 

Dyspepsia, 355 

Lumbricoides, 370 

Perforations, 364 

Tape Worm, 371 

Worms, 369 

Intra-Uterine Catarrh, 861 

Intussusception, 363 

Inversion of the Uterus, 541 

Involution of the Uterus, 542 

Irritation, Spinal, 226 

Irreducible Hernia, 431 

Irritable Bladder, 465 

Ulcer 652 

or Inflamed Ulcer, 527 

Iris 610 

Irish Moss, 780 

Irritant Vegetable Poisons 768 

Irritating Plaster, 864 

Iron, 827, 831, 765 

Acetic Tincture of, 879 

by Hydrogen, 879 

Muriated Tincture, 879 

Perchloride of, 807 

Pills 832 

and Quinine 799 

Ischiatic Hernia, 435 

Itch Benzine, 849 

Jaborandi, 823 

Jalap, 871 

Jaundice, 407 

Jaw Fracture, 686 

Joints, . 689 

Wounds, . . 667 

Keloid, 647 

Keph aline Glycerite, 880 

Keratitis, 609 

Kerophalmia, 617 

Kidney, Aching, 721 

Bleeding, 450 

Calculi, 457 

Cancer, 448 

Collapse, 440 

Degeneration, 445 

Dropsy, 447 

Gravel, 451 

Inflammation 439 

Neuralgia, 455 

Parasites, 449 

Tubercle, 448 

Kleptomania, 214 

Knock-knees, 745 

Kurchicine, 856 

Labor, 705 

Labial Hernia 435 

Laceration of the Perinseum, .... 718 

Lachrymal or Tear Duct 617 

Lacteal Tumor of Breast, 593 

Laryngitis, Acute 290 

Chronic 291 

Clericorum, 293 

Lateral Sclerosis of Cord 244 

Curvature, 678 



PAGE 

Lead 765 

Colic, 365 

Paralysis, 247 

Lemonade, 779 

Saline 796 

Juice, 618 

Lepra, 643 

Leucocytheemia 152 

Leucoderma, 648 

Leucorrhcea, Infantile," 501, 548 

Lichen (Varieties) 643 

Lightning, 754 

Limbs Torn by Violence, 752 

Lime, Chloride, 786, 801 

Iodide 786 

Tincture of Iodide 844 

Water, 796, 845-847 

Liniment, 840 

Aconite, Belladonna, and Chloro- 
form, 863 

Capsicum, . . 863 

Carbolic Acid, 864 

Chilblains 843 

Croton Oil, 863 

Hemlock, 863 

Lime Water, 863 

Magic, 843 

Pain, 843 

Stimulating, 863 

Liquor Ammonia Acetatis, 796 

Chlorinated Soda, 801 

Potassa, 795 

Liquid for Corns, 865 

for Physic, 870 

Lithia, 795 

Liver, Atrophy, 401 

Cancer, 404 

Degeneration, 399 

Hypertrophy 402 

Inflammation, 393 

Pigment, 401 

Tumor, 403 

Lobelia, 793, 797, 806, 829, 872, 873 

and Belladonna, 873 

and Blood Root, 819 

and Capsicum and Valerian, . . . 797 

and Capsicum, 873 

Compound, 798-830 

Infusion 819-847 

Ox Gall, 849 

Poultice, 867 

Tincture, 830 

Local Anaesthesia, 792 

Paralysis, 242 

Locomotor Ataxia, 242 

Logwood, 802-806 

Longevity, 66 

Loss of Speech (Aphasia), 197 

of Voice, 294 

Lotion for Sweaty Feet 849 

for Diphtheria, 849 

Lotions, 845 

Lousiness, 660 

Lumbricoides. 875 

Lymphatic Temperaments, 67 

Glands, 436 



Madness, Puerperal, 719 

Magic Liniment, 843 

Magnesia, 795 

and Sulphur, 871 

Malarial Fever 83 

Malignant Fever, 91 

Pustule, 655 

Ulceration 659 

Malformation, 743 

Urethra, 474 

Malt Extract, 781 

Management of the Infant at Birth, . . 725 

Mandrake' 871 



INDEX. 



897 



PAGE 

Mania 213 

Puerperal, 216 

Marasmus, 424 

Massage 234,849 

Masturbation, 488 

Matrix of Nails, 656 

Mastodynia, 589 

Meal, Linseed, Poultice, 866 

Measles 118 

Meat Juice, Raw 777 

Meconium Retention, 733 

Medicated Poultices, 867 

Medicine, Science, 17 

Melancholia, 213 

Melsena 360 

Melanotic Tumors, 663 

Mellituria, 160 

Membrana Tympani, Relaxation, . . 625 

Membranes of Brain, 189 

Meningitis, 224 

Simple 188 

Tubercular, 190 

Menorrhagia, 518 

Menstruation, 511 

during Pregnancy, 702 

Lactation, 702 

Menthol, 802 

Ointment 841 

Mensuration, 45 

Mercury, 766 

Mercurial Aphthse, 332 

Paralysis 247 

Poisoning 179 

Ulcers on Tongue 329 

Metals 764 

Metritis, Acute, 520 

Chronic 522 

Microscope, 64 

Micro-Organisms, 113 

Milk Fever 720 

Food 778 

in the Breast of Infants 733 

and Lime-water, 776 

Leg, . . ft 280 

Miliary Fever, 720 

Mineral Water Baths, 881 

Missed Abortion, 715 

Mixtures, 822 

Moist Rattles, 49 

Moles, 658 

Mollities Ossium, 675 

Molluscum, 647 

Monomania, 213 

Morbus, Cholera, 379 

Mortification, 79 

Mortis, Rigor, 772 

Mortality, Infant, 738 

Morphia", 793 

Hvpodermically, 837 

Moss. Iceland, 820 

Hair Cap 828 

Mother's Cordial, 875 

Mouth, 731 

Muco- Purulent Diarrhoea, 360 

Mucous Cvsts of Breast, 595 

Mumps, 336 

Muriate of Ammonia 820 

Muriatic Acid Gargle, 834 

Muscse Volitantes, 601 

Muscular Atrophy, 669 

Progressive 245 

Hypertrophy, 670 

Rupture, 670 

Mustard Foot-Bath 813 

Poultice, 867 

and Salt, 829 

Seed, White, 881 

Mutilations, 705 

Mutton Soup, 777 

Myalgia, 668 

Myelitis, Spinal, 223 



PAGE 

Mydriasis, 601 

Myostitis 668 

Myopia 597 

Myosis 601 

Naevus, ' . 278 

Arterial, 278 

Capillary, 278 

Venous, 279 

Narcotic Enema, 833 

Poisons, 761, 769 

Nasal Duct, 617 

Polypus 290 

National Weakness, 30 

Necrosis of Bone, 674 

of the Teeth 331 

Neck, 666 

Ulceration, 862 

of Womb, . 861 

Nephralgia, 4-55 

Nervous Colic, 365 

Deafness, 629 

Headache, 183 

Temperament 67 

Neuralgia, 249,389 

of the Breast, 589 

of the Coccyx, 721 

of the Heart, 266 

of the Kidney, 455 

of the Teeth, 331 

of the Testes, 484 

of the Uterus, 862 

Neuritis, 252 

Neuroma, 252 

Neutralizing Mixture, 808 

Nightmare, 218 

Nine Dav Fits, 737 

Nitre, 827 

Nitric Acid 807 

Nitrous Oxide Gas, 788 

Nitrite of Amvl, 774 

Nitro-Glvcerine 828 

Nitro-Muriatic Acid, 882 

Noises in the Ear, 626 

Non-expansion of Air-Ceils in Lung, . 736 

Union of Bone, 684 

Nose, Fracture, 686 

Foreign Bodies in, 753 

Wounds, 666 

Nourishment, 776 

Nursing Sore Mouth 743 

Nutrition of the Infant, 746 

Nux Vomica, 798 

Nyctalopia, ,. ... 600 

Nymphomania, ' . . . . 505 

Obesitv, 417 

Obstruction of the Bowels, 362 

Occlusion of the Vagina, 506 

of the Eustachian tube, 625 

Obturator Hernia, 435 

CEsophagism 339 

Oesophagitis, 33S 

CEsophagus, Cancer of, 341 

Organic 340 

Spasmodic Stricture of, 339 

Stricture of, 339 

Oil of Bitter Almonds, 7.17 

Ointments, 840 

Ointment, Basilicon 840, 844 

Belladonna and Iodide, 

Borax, 841 

Cadmium, 840 

Chloral Hydrate, 841 

Chrvsophanic 841 

Iodide of Lead, 840 

Iodoform 841-842 

Menthol, Ml 

Pile fc42 



INDEX. 



PAGE 

Ointment, Pyrogallic, 841 

Soothing, 842 

Sulphur 840-844 

Sulphuric Acid 841 

Thymol, 841 

Various others, 840 

Vaseline 842 

Vegetable 844 

Olfactory Nerve 283 

Onion Syrup, 819 

Poultice, 866 

Opacities of the Cornea, 610 

Open Condition of the Eustachian Tube, 625 

Ophthalmia, Catarrhal, 608 

Common Acute 604 

Gonorrhoea^ 606 

Granular, 607 

Infantile, 603 

Purulent, 605 

Rheumatic, 608 

Sympathetic, 608 

Tarsi, 601 

Tubercular, 606 

Opium, 793 

and Belladonna, 873 

Coma, 185 

Habit, 254 

and Hyoscyamus 873 

and Ipecacuanha, 794 

and Tannin, 873 

Oraline 869 

Organic Aphonia, 294 

Headache, . 183 

Poison, 767 

Osseous Tumors, 663 

Ostitis, 673 

Otalgia 627 

Other Morbid States in Child-birth, . . 722 

Otorrhoea. 622 

Ovaries, 542 

Inflamed 542 

Ovarian Displacement, 549 

Tumors, 545 

Oxalic Acid Diathesis 454 

Oxaluria 454 

Ox-Gall Lotion, 849 

Ozsena, . 287 

Ozone et Chlorine, 853 

Ozone, Glycerite of, . 880 

Ozonized Chloride of Chromium, . . . 853 

Clay 854 

Eucalyptus, 856 

Glycerine, 851 

Kephaline, 853 

Ointment, 855 

Phytolacca, 858 

Remedies, 851, 858 

Saxifragica, 855 

Water, 852 

Pain of Cancer, 862 

Killer, 843 

Painful Sitting, 722 

Pancreas, 412 

Pancreatine, 780 

Palpitation, 44 

Pulse, 52 

Papulae, 641 

Paraffme, 859 

Parasitici, 637 

Paralysis, 238 

Agitans, 248 

Bladder, 466 

Diphtheria 246 

Hysterical 245 

Infantile 244 

Lead, 247 

Local, 242 

Mercurial, 247 

Pseudo-, 246 



PAGE 

Paralysis, Rheumatic, 245 

Paraphimosis, 470 

Parasites in Kidney, 449 

Paraplegia, 240 

Syphilitic 242 

Parotitis 336 

Parsley Root, 831 

Partridgeberry, 874 

Pastiles, 860 

Patella, Fracture 688 

Pathology 27 

Peculiarities of Infants, 727 

of Diseases, , . 728 

Pelvic Hematocele, 548 

Pelvis, Fracture 688 

Inflammation, 549 

Pellagra, 156 

Pemphigus, 636 

Pepsin, 780-783 

Percussion, 45 

Pericarditis, . . . 263 

Peritonitis, 420 

Acute 421 

Chronic 422 

Perineal Hernia, 435 

Periostitis, 672 

Perineum, Laceration, 718 

Peritonitis, Puerperal, 720 

Permanganate of Potassa, 801 

Gargle, 836 

Wash, 846 

Perchloride of Iron 807 

of Lime, 873 

Peruvian Bark, 883 

Pessaries or Pastiles, 860 

Perforations of Intestines, 364 

Personal Health, 42 

Pharcy, 174 

Phlegmasia Dolens, 280 

Phlebitis 279,767 

Pharyngitis, 337 

Phagedena of Scrotum, 487 

of Ulcer, £ . . . . 655 

Phimosis k .... 469 

Phosphorus,_ ™ . . 180, 880 

Phosphates, Jrine, 63 

Phosphate of Soda, 797,870 

Phosphoric Acid, . . .' 880 

Drink 796 

Photophobia, 600 

Phthisis 321 

Physic, White Liquid, 870 

Phytolacca, 785, 858- 

Pityriasis 644 

Plasters, 863 

Corn 864 

Irritating, 864 

Strengthening, 865 

Tar, 864 

Warm, 864 

Plague, 102 

Pleurodynia, 318 

Pleurisy, Acute, 316 

Chronic, 317 

Piarrheemia, 159 

Pigment, Lime, . 401 

Piles 390 

External 390 

Internal 390 

Ointment, 842 

Pill, Alterative 787 

Spermatorrhoea, 799 

Pilocarpine, Hypodermically, .... 838 

Pink Eye, 175 

Mai row, 436 

Pneumonia, 310 

Chronic 315 

Podophvllum 785 

Poison of Subjects, 176 

Poisoning, Mercurial, 179 

Poisonous Gases 758 



INDEX. 



899 



PAGE 

Poisonous Fish, 770 

Mushrooms, 770 

Sausages 770 

Serpents, 771 

Poisons 762 

Animal, 770 

Inorganic, 702 

Organic 767 

Polypus of the Ear, 624 

of the Nose, 290 

of the Rectum, 389 

of the Uterus, 536 

Pork Worm, 372 

Post-Morteni, 771 

Position, 57 

Posterior Curvature, 679 

Posture and Gait, 57 

Potassa Chlorate, 802 

Permanganate, 801 

Poultices, 865 

Alkaline 866 

Antiseptic, 867 

Alum, 868 

Bran, 865 

Bread and Milk, 866 

Carrot 867 

Charcoal, 867 

Cranberrv, 867 

Indian Turnip, 868 

Linseed, 866 

Lobelia, 867 

Medicated, 867 

Mustard, 867 

Onion, 866 

Slippery Elm 866 

Vinegar, 868 

Pregnancy, 695 

Symptoms, 701-704 

Preservation of the Teeth, 868 

Pre>byopia, 595 

Preputialis, Herpes, 471 

Priapism, 475 

Prickly Ash 824-826 

Procidentia, 539 

Protuberant Eyeballs, 601 

Prolapsus, 539 

of the Rectum, 387 

of the Vagina, 509 

Prostate Gland, Acute, Inflamed, . . . 476 

Chronic, Inflamed, 477 

Prostatorrhcea, 480 

Prostration, 69 

Progressive Muscular Atrophy, .... 245 

Prunes and Senna, ......... 870 

Pruritis Fudendi, 703 

Prussic Acid, 762 

Pruritus Vulvae, 861 

Prurigo 642 

Psoas Abscess, 677 

Psoriasis 643 

Psychology 28 

Pterygion, 609 

Ptosis 603 

Pudendal, 435 

Erythema, 501 

Hematocele, 503 

Puerperal, Ill 

Convulsions, 212,720 

Fever, 718 

Mania, 216, 719 

Peritonitis, 720 

Tetanus, 222 

Puff Powder, 814 

Pulmonary Cancer, 320 

Condensation, 319 

Consumption, 320 

Gangrene, 320 

Purpura 154 

Purulent Ophthalmia, 605 

Purifier of Blood 787 

Purgatives, 870 



PAGE 

Pus, 63 

Pustulae, 636 

Pyromania, 214 

Pyrosis.. 350 

Pyrogallic Acid Ointment, S41 

Quinine 799, 837 

and Acid 883 

and Hydrastin 879 

and Salicylate of Soda 805 

Rabies, 172 

Races, 20-37 

Ranula, 330 

Rattles, 49 

Raw Meat Juice, 777 

Rectum, Cancer, 389 

Gonorrhoea, 392 

Inflammation, 385 

Neuralgia, 389 

Polypus, 389 

Prolapsus, 387 

Stricture, 386 

Ulcers, 387 

Recto-Vaginal Fistula, 719 

Reducible. Hernia, 430 

Red Gravel, 451,455 

Reflex Action 219 

Refreshing Bath 814 

Reflex Sedatives, 871 

Regimen and Diet, . 235 

Relapsing Fever, 91 

Remittent Fever 88 

Bilious Fever 91 

Bilious Fever, Malignant, .... 91 

Remedial Agents, 773 

Rennet Whey, 779 

Respiration, 732 

Restoration of the Drowned, .... 758 

Ret ro-Pharyngeai Abscess, 338 

Retroversion, 541 

Retinitis, 612 

Retention of the Afterbirth, 711 

of the Meconium, 733 

of the Urine, 754 

Rhubarb and Potassa, 808 

Rheumatic Alterative, 786-787 

Ophthalmia, 608 

Paralysis 245 

Rheumatism 163 

of the Ear, 628 

in Joints, 690 

Rheumatoid Arthritis, 171 

Ribs, Fracture, 6b7 

Rice Water, • 779 

Rickets 676 

Rigor Mortis, 772 

Ringworm, 637 

Rochelle Salts, 870 

Rodent Ulcer, Neck of Womb 528 

Rosin Weed in Asthma, 820 

Roseola 631 

Rotheln 119 

Rubbing or Friction Sound, 49 

Rubeola 118 

Notha, 119 

Rupia, 636 

Rupture of the Heart 273 

Muscles, 670 

Uterus, 720 

Rupture or Hernia 429 

Irreducible, .... 431 

Reducible, 430 

Strangulated, .... 431 

Russian Bath, 812 

Sabina, 831-832 

Sage, 824 



900 



INDEX. 



PAGE 

Sage Tea and Honey Gargle, . . . 835-837 

Salicylate Soda, 803 

Salines, 795-870 

Saline Lemonade, 7% 

Salt Water Baths 811 

Salts 870 



6 IX 



Salve for Breast and Testicles, . 
Sanguine Temperament, . . . 

Santonin, 

SarcinaB Ventriculi 

Sausage, Poisonous, 

Saxifragica, 

Scabies, 

Scalds, 

Scalps, 

Scapula Fracture, 

Scarlet Fever, 

Anginosa, 

Malignant, 

Simple, 

Sciatica, 

Science of Medicine 

Scleroma, or Hide-bound, 

Sclerosis of Spinal Cord, 

Scrofula, 

Scrotal Effusion, 

Elephantiasis, 

(Edema, 

Scurvy, 155 

Sea-Sickness 

Seat-Worms 

Sebaceous Tumors, 

Sedatives, Arterial, 

Reflex, 

Seidlitz Powder, 

Self-Abuse 

Sensation, 

Senna and Prunes, ......... 

Serous Diarrhcea 

Serpentaria Compound, 

Serpents, 

Sexes. Determination of, 

Sexual Invigorator, 

Shallow Bath, 

Shepherd's Purse 

Shock 69 

Shower Bath 

Simple Bilious Fever, 

Continued Fever,' 

Sight, Acute at Twilight, 

Color Blind, 

Double, 

Faulty, . 

Intolerance, 

Longsightedness, 

Night-blind, 

Normal 

Over, 

Specks, 

Spots, 

Styes, 

Variations, 

Weak, 

Signs and Symptoms of Pregnancy, . . 

Silver, 

Simple Enema, 

Tonic, 

Ulcer of Neck of Womb, 

Sitting, Painful, 

Skin, 50, 

Enamel 

Skull, Fracture of, 

Sleep, 

Sleeplessness, 

Slippery-Elm Poultice, 

Sloughing Ulcer, 

Small-Pox 

Smell, 60, 

Snake-bite, 

Snoring, 

Soap-wash 



PAGE 

Soda, Phosphate of, 870 

Softening of the Brain, Red, 194 

White 194 

Cerebellum, .... 195 

Solid Food 780 

Solution of Atropia 846 

Soothe Cough 821 

Soothing Gargle, 836 

Ointment 842 

Spasm of Bladder, 466 

Spermatorrhoea, 488 ' 

Pills, 799-856 

Sphygmograph 66 

Spina Bifida. 677 

Spinal Cord, Ansemia of, 229 

Curvature, 678 

Diagnosis 66 

Fractures, 685 

Haemorrhage 225 

Irritation, 226 

Spine, Sclerosis of, 244 

Tumors of, 225 

Spirometer, 65 

Spleen 413 

Spurious Pregnancy, 704 

Spotted Fever, 110 

Squamous Skin Affections, 643 

Squinting, 618 

Stammering, 251 

Starch, 811 

and Glycerine, 863 

Starchy Degeneration, 397 

Sterility in Man, 497 

in Woman 498 

Stertorous Breathing, 303 

Still-Born, 734 

Stillingia and Iodide Potassa, .... 785 

Stomach, Cancer of, 345 

Catarrh of, 351 

ofChild, 323 

Cramps, 350 

Dilatation of, 344 

Haemorrhage of, 341 

Inflammation of, 342 

Thickening of, 344 

Ulcers of, 345 

Stomachic Tonic, 841 

Stomatitis, Follicular, 383 

Gangrenous, 333 

Ulcerative 333 

Stone in Bladder, 458 

in Kidney, 458 

in Urethra, 458 

Stones, Gall, 405 

Stools 58, 732 

Stoppage of Urine 828 

Strains, 679 

Strangulated Hernia, 431 

Strangulation, 758 

Strawberry Leaves, 806 

Strengthening Plaster, 866 

Stricture of the (Esophagus, 339 

Organic 340 

Spasmodic, 339 

of the Rectum, 386 

of the Urethra, 472 

Strong Coffee for Chills, 803 

Struma, 130 

Styptic Colloid 864 

Subcutaneous Injections, 837 

Atropia, 837 

Morphia 837 

Pilocarpine, 838 

Quinia 837 

Sudamina 633 

Sugar in Urine 63 

Suicide 216 

Sulphite of Soda, 802 

Sulphur 787,870,871 

Bath, 811 

and Cream Tartar, 827 



INDEX. 



901 



PAGE 

Sulphur to Disinfect, ...;.... 803 

Gargle 835-836 

and Manganese, 871 

Saccharate of, 802 

Tincture of, 787 

Sulphurous Acid, 802 

Wash, S46 

Sulphuric Acid, 87C 

Sumbul 797 

and Bromine, 876 

Sun-struck, 204-754 

Supersulphate of Zinc, 818 

Suppositories, 872 

Suprarenal Capsules, 459 

Surgical Fevers, 116 

Hectic, 117 

Intermittent, 117 

Irritative, 117 

Typhoid, 117 

Sweating Drops 823 

Powder 823-824 

Sweaty Feet and Hands, 656 

Sweet Oil 818 

Sweet Spirits Nitre, 826 

Swelling of the Breast 733 

Sympathetic Ophthalmia, 608 

Syncope, 761-765 

Synovitis, Acute, 689 

Chronic, 690 

Syphilis 141 

Syphilitic Aphthae, 332 

Hepatitis, 398 

Keratitis 609 

Syphilitic Paraplegia, 242 

Ulceration of Neck of Uterus, . . . 529 

of Pharynx, 337 

Ulcers on Tongue, 327 

Syrup, Alterative 787 

of Bloodroot, Acetic, 819 

Bromohydric, 820 

of Ipecacuanha, 819 

of Onions, 819 

of Senega, 820 

ofTolu, 820 

of Wild Cherry 820 

Systolic Sound, 50 

Tabes Mesenterica, 424 

Tannic Acid and Chlorate Potassa Gargle, 836 

Tannin, 806-808 

and Nitric Acid, 807 

Tansy 831 

Tape-Worm, 875 

Tapioca 7"9 

Tar Plaster, 864 

Water 848 

Tartrate of Sodium, 796 

Tea 252 

Tear-Duct, 617 

Teeth, Filling, 869 

Preservation of, 688 

Preserver, 868 

Washes for 868 

White, 868 

Temperaments, 67 

Temperature, 59 

Testes, Neuralgic 484 

Tubercular, 484 

Testicle, Abscess of, 483 

Enlargement of, 485 

Wasting of, 485 

Testitis, Acute, 481 

Chronic, 483 

Tetanus, 219 

Puerperal, 222 

The Appetite 54 

The Child— Its Diseases, 723 

The Circulation 732 

The Cry, 731 

The Mouth and Breath, ... 731 



PAGE 

The Child— The Skin, 731 

The Sleep 731 

The Teething 740 

The Temperature, 731 

The Tongue-tie 744 

The Trance, 755 

The Urine, ." . 732 

The Yellow Gum, 733 

The Ear 619 

Theomania, 214 

The Plague, 102 

The Pulse 52 

The Skin, 54 

The Tongue, 53 

Thickening of the Walls of the Ab- 
domen, 344 

Thirst, 54 

Throat Wounds, 666 

Thymol 802 

Ointment 841 

Tic-douleureux 249 

Tincture Digitalis, 805 

Green Root Gelseminum, .... 805 

and Quinine, .... 805 

Lobelia 806 

Tinea Decalvans, 640 

Favosa 640 

Sycosis, 640 

Versicolor 640 

Tin Colic 365 

Tinnitus Aurium, 626 

Toast, Water, 779 

Tobacco Habit «... 253 

Tongue, 353 

Cancer of, 330 

Cracked, 329 

Hypertrophy of, . 229 

Mercurial, 329 

Strawberry 328 

Syphilitic Ulcers on, 329 

Tubercular, 329 

Tumors of, 329 

Tie, 329 

Ulcers on, 328-329 

Warts on, 329 

Tonics, , . .879-883 

Wine 880 

Stomach, 881 

Tonsil, Cancer of, 336 

Tonsils, Exhalations from, 336 

Tonsilitis, Acute, 334 

Chronic, 335 

Toothache 330-369 

From Caries 330 

Inflamed Pulp, 331 

Necrosis, 331 

Neuralgia 331 

Trichiasis 602 

Trichiniasis, 372 

Trismus Nascentium, 222 

Tubercul33, Skin, 644 

Tubercle on the Kidney, 448 

Tubercular Aphthae, 332 

Deposits in Brain, 195 

in Liver, 403 

Disease of the Joints, 691 

Meningitis, 190 

Ophthalmia 606 

Testes, 484 

Ulcers 653 

Tuberculosis, 130 

Turkish Bath 813 

Tumors, 661 

of the Antrum 681 

in the Bladder, 467 

Brain, 195 

Breast, 593 

Calcareous, 403 

Cartilaginous, 663 

Cavernous, 403 

Colloid 663 



902 



INDEX. 



PAGE 

Tumors, Cystic, 663 

in Liver 403 

Cysts, 536 

Fatty, 662 

Fibroid, 535 

Glandular 663 

Hydatid, .403 

in Liver, 403 

Melanotic, 663 

Osseous, 663 

of Ovary, 545 

Polypus, 536 

Sebaceous 663 

Spinal, 225 

en Tendons, 671 

Tongue 327 

and Tubercular Deposits, .... 403 

Uterine 682 

of Uterus, 534 

of Vagina, 511 

Turpentine 807 

Enema, 833 

and Sulphuric Acid 807 

Typhoid Fever, 92 

Typhus Fever, 99 

Ulcer of Duodenum, 355 

Fistulous, 654 

Gangrenous, 655 

Healthy, 652 

Indolent 653 

Irritable 652 

Malignant, 655 

Phagedenic, 655 

of the Rectum, 387 

of the Stomach, 345 

Tubercular 653 

Varicose, 654 

of the Vulva 504 

Ulcers on the Tongue, 329 

on the Cornea 610 

Ulceration 652, 736 

Of the Internal Cavity of Uterus, . 717 

of the Neck of Womb, . . . . . 525 

Ulcerative Stomatitis, 333 

Umbilical Hernia, 435 

Uraemia, 161, 185, 447 

Urethra, Fistula, 473 

Inflammation 471 

Malformation, 474 

Orifice, Vascular Tumors, .... 505 

Uric Acid, 63 

Diathesis, 451 

Urinary Calculi 457 

Urticaria, 632 

Uterine Remedies, 874 

Uterus, Cancer, 537 

Catarrh of Neck, 524 

Chronic 522 

Displacement, 538 

Acute Inflammation, 520 

Irritable Ulcer, 527 

Rodent Ulcer, 528 

Rupture, 720 

Simple Ulcer 527 

Ulceration of Neck, 525 

Uterine Catarrh, 529,862 

Haemorrhage, 534 

Tumors, 862 

UvaUrsi, . .827,828 

Uvula Elongation, 337 

Vaccination, 125 

Vaginal Hernia, 435 

Vagina, Acute Inflammation 507 

Chronic Inflammation, 508 

Occlusions, 506 

Prolapse, 509 

Tumor 511 



PARE 

Vaginismus, 506 

Valvular Disease of the Heart 269 

Valdivine, 858 

Valerian, 873 

Valerianate Ammonia, 882 

Variola, 125 

Varix, ...'... 282 

Varicose Veins, . 282 

Ulcer, 654 

Varicocele, 485 

Vascular Tumors at Orifice of Urethra, . 505 

Vaseline 840 

and Eucalyptus 842 

Iodoform, 842 

Vegetations 658 

Vegetable Acids, 767 

Alteratives, 785 

Ointments, 844 

Poisons, 768 

Veins, Inflammation, 279 

Venereal Warts, 392 

Disease 141 

Venomous Insects, 771 

Ventral Hernia, 435 

Vertigo, 182 

Auditory, 626 

Veratrum Viride, 804 

Vermifuge Remedies 875 

Vesicular Emphysema, 301 

Vesiculae 633 

Vesico-Vaginal Fistula 718 

Vibrating Murmur, 49 

Viburnum Compound, 874 

Valerian, 874 

Vinegar Lotion, 845 

Poultice, 868 

and Salt Gargle, 834 

Vital Capacity of Lungs, 64 

Vitiligo, 648 

Volatile Oils, 768 

Vomiting 732 

of Pregnancy, 699 

Vulva, Cancer, 504 

Corroding Ulcer, 504 

Encysted Tumors, 502 

Fibrous Tumors, . 503 

Follicular Inflammation, .... 500 

Gangrenous Inflammation, .... 500 

Inflammation, 500 

Pruritus, 499-861 

Warts ' 658,865 

on Tongue, 329 

Warty Growth, 503 

Water-Brash, 350 

Weakness, National, ^30 

Weaning Brash, 743 

Webbed Fingers and Toes, 746 

Weight of the Body, 61 

What are Disease Germs, 34 

Whey, . 779 

White Blood Cell 152 

Filling, 869 

Gravel 452-455 

Liquid Physic, 870 

Mustard Seed, 881 

Swelling, 691 

Teeth 869 

Wild Cherry, "94 

Wine, Partridge Berry, 874 

Port,. . . . . 883 

Whey, 780 

Womb, Catarrh, Neck, 861 

Catarrh 861 

Falling, 861 

Rigidity of Neck 861 

Worms 366 

in Blood, 171 

Common Round, 3/0 

Dracontiasis 375 



INDEX. 



903 



PAGE 

Worms, Filaria Sanguinosis Hominis, . 375 

Intestinal 369 

Remedies 875 

Seat 370 

Tape, 371 

Trichiniasis, 372 

Wounds, 177, 665 

Abdomen, 752 

Back of Neck 666 

Belly, 667 

Chest, 666, 752 

Ear, 666 

Gunshot 752 

Joints, 667 

Nose, 666 



PAGE 

Wounds, Perina?um, 752 

Scalp, 666 

Throat 606,752 

Wry-Neck-, 744 

Yeast Poultice, .867 

Yellow Fever, 102 

Wash, 848 

Zinc 766 

Chloride 801, 817 

Injection, 847 

Supersulphate, 818 



71 



NEW PHARMACEUTICAL PREPAKATIONS ! 

GLYCERITE OF OZONE, 

OR OZONIZED GLYCERINE. A POSITIVE CURE FOR 

CONSUMPTION. 

The hypo-phosphite of lime and soda are first added to glycerine, and then the 
whole is submitted to the action of chemically pure ozone gas. Ozone, the great 
scavenger of nature, the annihilator or destroyer of all micro-organisms or disease 
germs in the human blood and tissues, is added to the above mixture, and is found 
to be highly destructive to the germ tubercle, and has acquired an established rep- 
utation throughout the civilized world, as a positive cure for consumption. In this 
preparation there is a perfect assimilation and retention of the ozone, and the great 
disideratum of the age has been effected in providing a remedy, indispensable in all 
diseases in which living matter has been degraded into a disease-creating germ — 
always of the greatest utility, never contra-indicated. 

This combination of ozone is the most efficacious ever offered for the cure of 
pulmonary consumption, and all forms of tubercular disease; also very valuable in 
typhoid fever, diphtheria, and all forms of nervous exhaustion. 

All medical and scientific authorities have decided that ozone is the great vital- 
izing agent in nature, but up to the present time, there has been difficulty in obtain- 
ing it in sufficient quantities, and also in effecting its diffusion and cohesion with 
other bodies, in a state of unalterability. This difficulty has now been overcome by 
the present combination, which is perfect, and when taken is at once assimilated 
into the blood. We claim that this Glycerite of Ozone, or ozonized glycerine, will 
positively cure consumption, in all cases and under all conditions. It not only 
destroys the disease-germ tubercle, but will arrest emaciation, check night-sweats, 
allay hacking cough, promote sleep, effectually prevent spitting of blood, increase 
the appetite, give strength and vigor to the entire body, and promotes a renewal of 
life in every organ and tissue. It is a restorative and anti-septic of the highest 
order. The most extraordinary beneficial results follow its use in all lung af- 
fections. 

From our method of preparing it, in an atmosphere of oxygen, the ozone is 
chemically pure, and entirely diffused through the compound, and from our definite 
process of manipulation, a positive uniformity of strength is obtained and insured. 
The precise amount of ozone in each pound is accurately known, its efficiency can be 
depended on, it never irritates, but on its administration an instantaneous improve- 
ment takes place in appetite, strength and flesh, and the symptoms of tuberculosis 
disappear as if by magic. Besides its intrinsic value in tubercular disease, it is of 
great utility as a nerve tonic, stimulant and vitalizer, and physicians and patient3 
who have used it claim it to be the best remedy in the materia medica for all broken- 
down or devitalized states. To the scientific physician, the value of the Glycerite of 
Ozone in pulmonary consumption is apparent, because it invariably depends upon, 
or is associated with a broken-down nervous system, which is the real cause of the 
formation of the disease-germ, and as it is purely constructive, as well as parasiti- 
cide, it is essentially indicated. 

For tubercular meningitis, tubes mesenterica, or wasting from lymphatic disease, 
no drug can enter the pink marrow and overcome the difficulty like this. Its action 
is almost miraculous in wasting, for which it is a perfect panacea. In induration 
of the brain, in paralysis of typhoid and diphtheria, in diabetis cholera infantum and 
nervous debility, it is of immense value. "When emaciation is great, the addition of 
one teaspoonf ul of it to three or four ounces of olive oil, rubbed into the body every 
night, is highly advantageous. 

DOSE — From 15 to 30 drops the first few days, thrice daily, in two or three table- 
spoonfuls of water; which is to be increased, in the course of a week, to 30 and 60 
drops as frequent. 

Glycerite of Ozone, or Ozonized Glycerine, is handsomely put up in pound 
bottles, $1.50 each, and may be obtained from all first-class druggists throughout the 
United States and Canada. 

Descriptive circulars furnished upon application. 

Correspondence with physicians solicited. 

J. BUCHANAN, M. D., 

Manufacturer a»d Sole Proprietor. 



LIBRARY OF CONGRESS 




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